| National Provider Identifier [NPI]: | 1447219548 |
| Last Name Of The Provider | MITCHELL |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 119 W HILL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | THOMASVILLE |
| Zip Code Of The Provider | 317926618 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 114 |
| Number Of Services | 12585 |
| Number Of Medicare Beneficiaries | 1584 |
| Total Submitted Charge Amount | 1320040 |
| Total Medicare Allowed Amount | 689530.54 |
| Total Medicare Payment Amount | 499573.23 |
| Total Medicare Standardized Payment Amount | 534248.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 530 |
| Number Of Medicare Beneficiaries With Drug Services | 119 |
| Total Drug Submitted ChargeAmount | 10310 |
| Total Drug Medicare AllowedAmount | 2988.05 |
| Total Drug Medicare PaymentAmount | 2235.48 |
| Total Drug Medicare Standardized Payment Amount | 2235.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 110 |
| Number Of Medical Services | 12055 |
| Number Of Medicare Beneficiaries With Medical Services | 1584 |
| Total Medical Submitted Charge Amount | 1309730 |
| Total Medical Medicare Allowed Amount | 686542.49 |
| Total Medical Medicare Payment Amount | 497337.75 |
| Total Medical Medicare Standardized Payment Amount | 532013.04 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 119 |
| Number Of Beneficiaries Age 65 to 74 | 597 |
| Number Of Beneficiaries Age 75 to 84 | 621 |
| Number Of Beneficiaries Age Greater 84 | 247 |
| Number Of Female Beneficiaries | 795 |
| Number Of Male Beneficiaries | 789 |
| Number Of Non Hispanic White Beneficiaries | 1503 |
| Number Of Black or African American Beneficiaries | 64 |
| 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 | 1376 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 208 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0472 |