| National Provider Identifier [NPI]: | 1619071826 |
| Last Name Of The Provider | SAMUELSON |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | O |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2800 PIERCE ST |
| Street Address 2 Of The Provider | STE 101 |
| City Of The Provider | SIOUX CITY |
| Zip Code Of The Provider | 51104 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 119 |
| Number Of Services | 2639 |
| Number Of Medicare Beneficiaries | 398 |
| Total Submitted Charge Amount | 679896 |
| Total Medicare Allowed Amount | 211305.36 |
| Total Medicare Payment Amount | 159744.62 |
| Total Medicare Standardized Payment Amount | 180377.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 876 |
| Number Of Medicare Beneficiaries With Drug Services | 113 |
| Total Drug Submitted ChargeAmount | 21168 |
| Total Drug Medicare AllowedAmount | 8623.29 |
| Total Drug Medicare PaymentAmount | 6744.97 |
| Total Drug Medicare Standardized Payment Amount | 6744.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 117 |
| Number Of Medical Services | 1763 |
| Number Of Medicare Beneficiaries With Medical Services | 398 |
| Total Medical Submitted Charge Amount | 658728 |
| Total Medical Medicare Allowed Amount | 202682.07 |
| Total Medical Medicare Payment Amount | 152999.65 |
| Total Medical Medicare Standardized Payment Amount | 173632.18 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 159 |
| Number Of Beneficiaries Age 75 to 84 | 134 |
| Number Of Beneficiaries Age Greater 84 | 68 |
| Number Of Female Beneficiaries | 251 |
| Number Of Male Beneficiaries | 147 |
| Number Of Non Hispanic White Beneficiaries | 380 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 336 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1211 |