| National Provider Identifier [NPI]: | 1396756680 |
| Last Name Of The Provider | HOLSONBACK |
| First Name Of The Provider | SHAWN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 MEMORIAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | DALTON |
| Zip Code Of The Provider | 307202529 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 940 |
| Number Of Medicare Beneficiaries | 810 |
| Total Submitted Charge Amount | 831467 |
| Total Medicare Allowed Amount | 146599.37 |
| Total Medicare Payment Amount | 113508.58 |
| Total Medicare Standardized Payment Amount | 116592.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 940 |
| Number Of Medicare Beneficiaries With Medical Services | 810 |
| Total Medical Submitted Charge Amount | 831467 |
| Total Medical Medicare Allowed Amount | 146599.37 |
| Total Medical Medicare Payment Amount | 113508.58 |
| Total Medical Medicare Standardized Payment Amount | 116592.99 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 280 |
| Number Of Beneficiaries Age 65 to 74 | 221 |
| Number Of Beneficiaries Age 75 to 84 | 194 |
| Number Of Beneficiaries Age Greater 84 | 115 |
| Number Of Female Beneficiaries | 468 |
| Number Of Male Beneficiaries | 342 |
| Number Of Non Hispanic White Beneficiaries | 740 |
| Number Of Black or African American Beneficiaries | 43 |
| 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 | 449 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 361 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 42 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.9246 |