| National Provider Identifier [NPI]: | 1598715682 |
| Last Name Of The Provider | SALLOUM |
| First Name Of The Provider | VICTOR |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 848 N. ST. FRANCIS |
| Street Address 2 Of The Provider | STE. 2945 |
| City Of The Provider | WICHITA |
| Zip Code Of The Provider | 672143855 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 3382 |
| Number Of Medicare Beneficiaries | 1037 |
| Total Submitted Charge Amount | 967488.45 |
| Total Medicare Allowed Amount | 295423.47 |
| Total Medicare Payment Amount | 224137.61 |
| Total Medicare Standardized Payment Amount | 236265.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 14 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 550 |
| Total Drug Medicare AllowedAmount | 456.35 |
| Total Drug Medicare PaymentAmount | 379.96 |
| Total Drug Medicare Standardized Payment Amount | 379.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 3368 |
| Number Of Medicare Beneficiaries With Medical Services | 1037 |
| Total Medical Submitted Charge Amount | 966938.45 |
| Total Medical Medicare Allowed Amount | 294967.12 |
| Total Medical Medicare Payment Amount | 223757.65 |
| Total Medical Medicare Standardized Payment Amount | 235885.13 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 247 |
| Number Of Beneficiaries Age 65 to 74 | 396 |
| Number Of Beneficiaries Age 75 to 84 | 293 |
| Number Of Beneficiaries Age Greater 84 | 101 |
| Number Of Female Beneficiaries | 558 |
| Number Of Male Beneficiaries | 479 |
| Number Of Non Hispanic White Beneficiaries | 910 |
| Number Of Black or African American Beneficiaries | 66 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 42 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 748 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 289 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 56 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 2.1206 |