| National Provider Identifier [NPI]: | 1790770329 |
| Last Name Of The Provider | DANIEL |
| First Name Of The Provider | JEROME |
| 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 | 1441 JOHNSTON WILLIS DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | RICHMOND |
| Zip Code Of The Provider | 232354730 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 3307 |
| Number Of Medicare Beneficiaries | 558 |
| Total Submitted Charge Amount | 462010 |
| Total Medicare Allowed Amount | 202710.46 |
| Total Medicare Payment Amount | 134763.4 |
| Total Medicare Standardized Payment Amount | 138213.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 1164 |
| Number Of Medicare Beneficiaries With Drug Services | 196 |
| Total Drug Submitted ChargeAmount | 10523 |
| Total Drug Medicare AllowedAmount | 4097.95 |
| Total Drug Medicare PaymentAmount | 3389.77 |
| Total Drug Medicare Standardized Payment Amount | 3389.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 2143 |
| Number Of Medicare Beneficiaries With Medical Services | 558 |
| Total Medical Submitted Charge Amount | 451487 |
| Total Medical Medicare Allowed Amount | 198612.51 |
| Total Medical Medicare Payment Amount | 131373.63 |
| Total Medical Medicare Standardized Payment Amount | 134824.12 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 274 |
| Number Of Beneficiaries Age 75 to 84 | 168 |
| Number Of Beneficiaries Age Greater 84 | 82 |
| Number Of Female Beneficiaries | 310 |
| Number Of Male Beneficiaries | 248 |
| Number Of Non Hispanic White Beneficiaries | 470 |
| Number Of Black or African American Beneficiaries | 72 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 538 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0179 |