| National Provider Identifier [NPI]: | 1356363915 |
| Last Name Of The Provider | FORD |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MS |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1901 MISSION 66 |
| Street Address 2 Of The Provider | |
| City Of The Provider | VICKSBURG |
| Zip Code Of The Provider | 391803711 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 122 |
| Number Of Services | 5756 |
| Number Of Medicare Beneficiaries | 642 |
| Total Submitted Charge Amount | 400785 |
| Total Medicare Allowed Amount | 204143.21 |
| Total Medicare Payment Amount | 146185.22 |
| Total Medicare Standardized Payment Amount | 155802.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 1305 |
| Number Of Medicare Beneficiaries With Drug Services | 305 |
| Total Drug Submitted ChargeAmount | 27653 |
| Total Drug Medicare AllowedAmount | 9535.14 |
| Total Drug Medicare PaymentAmount | 7518.71 |
| Total Drug Medicare Standardized Payment Amount | 7518.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 109 |
| Number Of Medical Services | 4451 |
| Number Of Medicare Beneficiaries With Medical Services | 642 |
| Total Medical Submitted Charge Amount | 373132 |
| Total Medical Medicare Allowed Amount | 194608.07 |
| Total Medical Medicare Payment Amount | 138666.51 |
| Total Medical Medicare Standardized Payment Amount | 148283.89 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 146 |
| Number Of Beneficiaries Age 65 to 74 | 250 |
| Number Of Beneficiaries Age 75 to 84 | 175 |
| Number Of Beneficiaries Age Greater 84 | 71 |
| Number Of Female Beneficiaries | 345 |
| Number Of Male Beneficiaries | 297 |
| Number Of Non Hispanic White Beneficiaries | 445 |
| Number Of Black or African American Beneficiaries | 185 |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 462 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 180 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1651 |