| National Provider Identifier [NPI]: | 1700854296 |
| Last Name Of The Provider | DATTA |
| First Name Of The Provider | JASON |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1432 S DOBSON RD |
| Street Address 2 Of The Provider | STE 201 |
| City Of The Provider | MESA |
| Zip Code Of The Provider | 85202 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 72 |
| Number Of Services | 1722 |
| Number Of Medicare Beneficiaries | 420 |
| Total Submitted Charge Amount | 1227849.42 |
| Total Medicare Allowed Amount | 317980.37 |
| Total Medicare Payment Amount | 236732.92 |
| Total Medicare Standardized Payment Amount | 242117.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 46 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 898.5 |
| Total Drug Medicare AllowedAmount | 160.18 |
| Total Drug Medicare PaymentAmount | 116.47 |
| Total Drug Medicare Standardized Payment Amount | 116.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 1676 |
| Number Of Medicare Beneficiaries With Medical Services | 420 |
| Total Medical Submitted Charge Amount | 1226950.92 |
| Total Medical Medicare Allowed Amount | 317820.19 |
| Total Medical Medicare Payment Amount | 236616.45 |
| Total Medical Medicare Standardized Payment Amount | 242000.95 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 228 |
| Number Of Beneficiaries Age 75 to 84 | 107 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 235 |
| Number Of Male Beneficiaries | 185 |
| Number Of Non Hispanic White Beneficiaries | 388 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 402 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1056 |