| National Provider Identifier [NPI]: | 1982603668 |
| Last Name Of The Provider | AMIGO |
| First Name Of The Provider | ROGER |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5131 BEACON HILL RD |
| Street Address 2 Of The Provider | SUITE 220 |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 432284442 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 2755 |
| Number Of Medicare Beneficiaries | 737 |
| Total Submitted Charge Amount | 736326 |
| Total Medicare Allowed Amount | 248129.02 |
| Total Medicare Payment Amount | 180939.88 |
| Total Medicare Standardized Payment Amount | 193821.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 166 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 112318 |
| Total Drug Medicare AllowedAmount | 35330.37 |
| Total Drug Medicare PaymentAmount | 26607.88 |
| Total Drug Medicare Standardized Payment Amount | 26607.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 2589 |
| Number Of Medicare Beneficiaries With Medical Services | 737 |
| Total Medical Submitted Charge Amount | 624008 |
| Total Medical Medicare Allowed Amount | 212798.65 |
| Total Medical Medicare Payment Amount | 154332 |
| Total Medical Medicare Standardized Payment Amount | 167213.6 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 184 |
| Number Of Beneficiaries Age 65 to 74 | 294 |
| Number Of Beneficiaries Age 75 to 84 | 188 |
| Number Of Beneficiaries Age Greater 84 | 71 |
| Number Of Female Beneficiaries | 231 |
| Number Of Male Beneficiaries | 506 |
| Number Of Non Hispanic White Beneficiaries | 657 |
| Number Of Black or African American Beneficiaries | 56 |
| 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 | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 467 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 270 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4361 |