| National Provider Identifier [NPI]: | 1518942077 |
| Last Name Of The Provider | POWELL |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1111 GLYNCO PKWY |
| Street Address 2 Of The Provider | BLDG 1 STE10 |
| City Of The Provider | BRUNSWICK |
| Zip Code Of The Provider | 315257921 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 110 |
| Number Of Services | 10729 |
| Number Of Medicare Beneficiaries | 1745 |
| Total Submitted Charge Amount | 584474 |
| Total Medicare Allowed Amount | 308032.21 |
| Total Medicare Payment Amount | 198884.74 |
| Total Medicare Standardized Payment Amount | 214770.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 26 |
| Number Of Drug Services | 5781 |
| Number Of Medicare Beneficiaries With Drug Services | 667 |
| Total Drug Submitted ChargeAmount | 71579 |
| Total Drug Medicare AllowedAmount | 4068.6 |
| Total Drug Medicare PaymentAmount | 3032.89 |
| Total Drug Medicare Standardized Payment Amount | 3032.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 84 |
| Number Of Medical Services | 4948 |
| Number Of Medicare Beneficiaries With Medical Services | 1744 |
| Total Medical Submitted Charge Amount | 512895 |
| Total Medical Medicare Allowed Amount | 303963.61 |
| Total Medical Medicare Payment Amount | 195851.85 |
| Total Medical Medicare Standardized Payment Amount | 211737.34 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 262 |
| Number Of Beneficiaries Age 65 to 74 | 906 |
| Number Of Beneficiaries Age 75 to 84 | 461 |
| Number Of Beneficiaries Age Greater 84 | 116 |
| Number Of Female Beneficiaries | 1032 |
| Number Of Male Beneficiaries | 713 |
| Number Of Non Hispanic White Beneficiaries | 1552 |
| Number Of Black or African American Beneficiaries | 147 |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1561 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 184 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9298 |