| National Provider Identifier [NPI]: | 1922298454 |
| Last Name Of The Provider | IM |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11950 COUNTY ROAD 101 |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | THE VILLAGES |
| Zip Code Of The Provider | 321629332 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 122 |
| Number Of Services | 21162 |
| Number Of Medicare Beneficiaries | 1701 |
| Total Submitted Charge Amount | 1168679.54 |
| Total Medicare Allowed Amount | 765762.9 |
| Total Medicare Payment Amount | 568146.7 |
| Total Medicare Standardized Payment Amount | 576787.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 6866 |
| Number Of Medicare Beneficiaries With Drug Services | 1096 |
| Total Drug Submitted ChargeAmount | 14903.5 |
| Total Drug Medicare AllowedAmount | 9398.54 |
| Total Drug Medicare PaymentAmount | 7408.25 |
| Total Drug Medicare Standardized Payment Amount | 7408.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 112 |
| Number Of Medical Services | 14296 |
| Number Of Medicare Beneficiaries With Medical Services | 1701 |
| Total Medical Submitted Charge Amount | 1153776.04 |
| Total Medical Medicare Allowed Amount | 756364.36 |
| Total Medical Medicare Payment Amount | 560738.45 |
| Total Medical Medicare Standardized Payment Amount | 569379.67 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 858 |
| Number Of Beneficiaries Age 75 to 84 | 644 |
| Number Of Beneficiaries Age Greater 84 | 171 |
| Number Of Female Beneficiaries | 942 |
| Number Of Male Beneficiaries | 759 |
| Number Of Non Hispanic White Beneficiaries | 1640 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1684 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9979 |