| National Provider Identifier [NPI]: | 1497759757 |
| Last Name Of The Provider | MITCHELL |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2310 COUNTRY RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHILOH |
| Zip Code Of The Provider | 622212570 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 4589 |
| Number Of Medicare Beneficiaries | 254 |
| Total Submitted Charge Amount | 197730 |
| Total Medicare Allowed Amount | 149674.2 |
| Total Medicare Payment Amount | 113251.99 |
| Total Medicare Standardized Payment Amount | 114685.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 206 |
| Number Of Medicare Beneficiaries With Drug Services | 166 |
| Total Drug Submitted ChargeAmount | 7690 |
| Total Drug Medicare AllowedAmount | 4863.55 |
| Total Drug Medicare PaymentAmount | 4646.62 |
| Total Drug Medicare Standardized Payment Amount | 4646.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 4383 |
| Number Of Medicare Beneficiaries With Medical Services | 254 |
| Total Medical Submitted Charge Amount | 190040 |
| Total Medical Medicare Allowed Amount | 144810.65 |
| Total Medical Medicare Payment Amount | 108605.37 |
| Total Medical Medicare Standardized Payment Amount | 110039.32 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 129 |
| Number Of Beneficiaries Age 75 to 84 | 65 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 148 |
| Number Of Male Beneficiaries | 106 |
| Number Of Non Hispanic White Beneficiaries | 240 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 237 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8409 |