| National Provider Identifier [NPI]: | 1669445706 |
| Last Name Of The Provider | DRISS |
| First Name Of The Provider | LEON |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 300 W WHITE MOUNTAIN BLVD |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | LAKESIDE |
| Zip Code Of The Provider | 859297014 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 94 |
| Number Of Services | 7720 |
| Number Of Medicare Beneficiaries | 1353 |
| Total Submitted Charge Amount | 696460.5 |
| Total Medicare Allowed Amount | 406074.46 |
| Total Medicare Payment Amount | 291737.32 |
| Total Medicare Standardized Payment Amount | 294930.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 600 |
| Number Of Medicare Beneficiaries With Drug Services | 278 |
| Total Drug Submitted ChargeAmount | 12400 |
| Total Drug Medicare AllowedAmount | 5299.07 |
| Total Drug Medicare PaymentAmount | 4971.68 |
| Total Drug Medicare Standardized Payment Amount | 4971.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 7120 |
| Number Of Medicare Beneficiaries With Medical Services | 1353 |
| Total Medical Submitted Charge Amount | 684060.5 |
| Total Medical Medicare Allowed Amount | 400775.39 |
| Total Medical Medicare Payment Amount | 286765.64 |
| Total Medical Medicare Standardized Payment Amount | 289959.24 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 111 |
| Number Of Beneficiaries Age 65 to 74 | 642 |
| Number Of Beneficiaries Age 75 to 84 | 435 |
| Number Of Beneficiaries Age Greater 84 | 165 |
| Number Of Female Beneficiaries | 694 |
| Number Of Male Beneficiaries | 659 |
| Number Of Non Hispanic White Beneficiaries | 1242 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 47 |
| Number Of American Indian Alaska Native Beneficiaries | 46 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1208 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 145 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2269 |