| National Provider Identifier [NPI]: | 1629071873 |
| Last Name Of The Provider | DALLEY |
| First Name Of The Provider | GARY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1515 RIVER PL |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | BRASELTON |
| Zip Code Of The Provider | 305175602 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 4211 |
| Number Of Medicare Beneficiaries | 734 |
| Total Submitted Charge Amount | 387320 |
| Total Medicare Allowed Amount | 211420.71 |
| Total Medicare Payment Amount | 161450.38 |
| Total Medicare Standardized Payment Amount | 163154.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 331 |
| Number Of Medicare Beneficiaries With Drug Services | 225 |
| Total Drug Submitted ChargeAmount | 11781 |
| Total Drug Medicare AllowedAmount | 7253.94 |
| Total Drug Medicare PaymentAmount | 6920.32 |
| Total Drug Medicare Standardized Payment Amount | 6920.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 3880 |
| Number Of Medicare Beneficiaries With Medical Services | 734 |
| Total Medical Submitted Charge Amount | 375539 |
| Total Medical Medicare Allowed Amount | 204166.77 |
| Total Medical Medicare Payment Amount | 154530.06 |
| Total Medical Medicare Standardized Payment Amount | 156234.13 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 415 |
| Number Of Beneficiaries Age 75 to 84 | 223 |
| Number Of Beneficiaries Age Greater 84 | 74 |
| Number Of Female Beneficiaries | 272 |
| Number Of Male Beneficiaries | 462 |
| Number Of Non Hispanic White Beneficiaries | 693 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 714 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.901 |