| National Provider Identifier [NPI]: | 1295728574 |
| Last Name Of The Provider | NIEUWOUDT |
| First Name Of The Provider | ERNST |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 45 MEDICAL CENTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | DAWSONVILLE |
| Zip Code Of The Provider | 305346297 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 2404 |
| Number Of Medicare Beneficiaries | 291 |
| Total Submitted Charge Amount | 213407.5 |
| Total Medicare Allowed Amount | 110915.86 |
| Total Medicare Payment Amount | 75465.67 |
| Total Medicare Standardized Payment Amount | 81173.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 277 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 7185 |
| Total Drug Medicare AllowedAmount | 4197.01 |
| Total Drug Medicare PaymentAmount | 3602.74 |
| Total Drug Medicare Standardized Payment Amount | 3602.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 2127 |
| Number Of Medicare Beneficiaries With Medical Services | 291 |
| Total Medical Submitted Charge Amount | 206222.5 |
| Total Medical Medicare Allowed Amount | 106718.85 |
| Total Medical Medicare Payment Amount | 71862.93 |
| Total Medical Medicare Standardized Payment Amount | 77570.59 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 153 |
| Number Of Beneficiaries Age 75 to 84 | 80 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 131 |
| Number Of Male Beneficiaries | 160 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 252 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9244 |