| National Provider Identifier [NPI]: | 1205895554 |
| Last Name Of The Provider | SLACK |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 179 NORTHAMPTON ST |
| Street Address 2 Of The Provider | #H |
| City Of The Provider | EASTHAMPTON |
| Zip Code Of The Provider | 010271057 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 174 |
| Number Of Services | 5061 |
| Number Of Medicare Beneficiaries | 783 |
| Total Submitted Charge Amount | 494715 |
| Total Medicare Allowed Amount | 205555.05 |
| Total Medicare Payment Amount | 159420.99 |
| Total Medicare Standardized Payment Amount | 158088.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 354 |
| Number Of Medicare Beneficiaries With Drug Services | 237 |
| Total Drug Submitted ChargeAmount | 11632 |
| Total Drug Medicare AllowedAmount | 7674.63 |
| Total Drug Medicare PaymentAmount | 7150.92 |
| Total Drug Medicare Standardized Payment Amount | 7150.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 159 |
| Number Of Medical Services | 4707 |
| Number Of Medicare Beneficiaries With Medical Services | 782 |
| Total Medical Submitted Charge Amount | 483083 |
| Total Medical Medicare Allowed Amount | 197880.42 |
| Total Medical Medicare Payment Amount | 152270.07 |
| Total Medical Medicare Standardized Payment Amount | 150937.19 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 201 |
| Number Of Beneficiaries Age 65 to 74 | 314 |
| Number Of Beneficiaries Age 75 to 84 | 176 |
| Number Of Beneficiaries Age Greater 84 | 92 |
| Number Of Female Beneficiaries | 495 |
| Number Of Male Beneficiaries | 288 |
| Number Of Non Hispanic White Beneficiaries | 708 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 523 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 260 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0219 |