| National Provider Identifier [NPI]: | 1629071527 |
| Last Name Of The Provider | HACKBARTH |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1814 ROSELAND BLVD |
| Street Address 2 Of The Provider | SECOND FLOOR, SUITE 200 |
| City Of The Provider | TYLER |
| Zip Code Of The Provider | 757014234 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 105 |
| Number Of Services | 7808 |
| Number Of Medicare Beneficiaries | 1222 |
| Total Submitted Charge Amount | 1929852.15 |
| Total Medicare Allowed Amount | 444374.57 |
| Total Medicare Payment Amount | 340807.54 |
| Total Medicare Standardized Payment Amount | 329341.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 1788 |
| Number Of Medicare Beneficiaries With Drug Services | 156 |
| Total Drug Submitted ChargeAmount | 27334.25 |
| Total Drug Medicare AllowedAmount | 15062.41 |
| Total Drug Medicare PaymentAmount | 11418.43 |
| Total Drug Medicare Standardized Payment Amount | 11418.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 98 |
| Number Of Medical Services | 6020 |
| Number Of Medicare Beneficiaries With Medical Services | 1222 |
| Total Medical Submitted Charge Amount | 1902517.9 |
| Total Medical Medicare Allowed Amount | 429312.16 |
| Total Medical Medicare Payment Amount | 329389.11 |
| Total Medical Medicare Standardized Payment Amount | 317923.05 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 431 |
| Number Of Beneficiaries Age 65 to 74 | 465 |
| Number Of Beneficiaries Age 75 to 84 | 279 |
| Number Of Beneficiaries Age Greater 84 | 47 |
| Number Of Female Beneficiaries | 733 |
| Number Of Male Beneficiaries | 489 |
| Number Of Non Hispanic White Beneficiaries | 1062 |
| Number Of Black or African American Beneficiaries | 116 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 937 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 285 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3598 |