| National Provider Identifier [NPI]: | 1275509705 |
| Last Name Of The Provider | DESANTIS |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 532 WEBB BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAVELOCK |
| Zip Code Of The Provider | 285322042 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 113 |
| Number Of Services | 3681 |
| Number Of Medicare Beneficiaries | 419 |
| Total Submitted Charge Amount | 336003 |
| Total Medicare Allowed Amount | 159667.83 |
| Total Medicare Payment Amount | 114654.52 |
| Total Medicare Standardized Payment Amount | 120535.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 235 |
| Number Of Medicare Beneficiaries With Drug Services | 82 |
| Total Drug Submitted ChargeAmount | 5483 |
| Total Drug Medicare AllowedAmount | 2661.25 |
| Total Drug Medicare PaymentAmount | 2310.46 |
| Total Drug Medicare Standardized Payment Amount | 2310.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 101 |
| Number Of Medical Services | 3446 |
| Number Of Medicare Beneficiaries With Medical Services | 419 |
| Total Medical Submitted Charge Amount | 330520 |
| Total Medical Medicare Allowed Amount | 157006.58 |
| Total Medical Medicare Payment Amount | 112344.06 |
| Total Medical Medicare Standardized Payment Amount | 118225.04 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 94 |
| Number Of Beneficiaries Age 65 to 74 | 203 |
| Number Of Beneficiaries Age 75 to 84 | 82 |
| Number Of Beneficiaries Age Greater 84 | 40 |
| Number Of Female Beneficiaries | 245 |
| Number Of Male Beneficiaries | 174 |
| Number Of Non Hispanic White Beneficiaries | 312 |
| Number Of Black or African American Beneficiaries | 73 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 315 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 104 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2356 |