| National Provider Identifier [NPI]: | 1134236979 |
| Last Name Of The Provider | MUMFORD |
| First Name Of The Provider | CONSTANCE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7901 ANGLING RD |
| Street Address 2 Of The Provider | SUITE B-201 |
| City Of The Provider | PORTAGE |
| Zip Code Of The Provider | 490240714 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 1074 |
| Number Of Medicare Beneficiaries | 530 |
| Total Submitted Charge Amount | 110494 |
| Total Medicare Allowed Amount | 71325.59 |
| Total Medicare Payment Amount | 47916.12 |
| Total Medicare Standardized Payment Amount | 49450.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 1074 |
| Number Of Medicare Beneficiaries With Medical Services | 530 |
| Total Medical Submitted Charge Amount | 110494 |
| Total Medical Medicare Allowed Amount | 71325.59 |
| Total Medical Medicare Payment Amount | 47916.12 |
| Total Medical Medicare Standardized Payment Amount | 49450.03 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 84 |
| Number Of Beneficiaries Age 65 to 74 | 244 |
| Number Of Beneficiaries Age 75 to 84 | 141 |
| Number Of Beneficiaries Age Greater 84 | 61 |
| Number Of Female Beneficiaries | 402 |
| Number Of Male Beneficiaries | 128 |
| Number Of Non Hispanic White Beneficiaries | 500 |
| 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 | 477 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 53 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9655 |