| National Provider Identifier [NPI]: | 1558306019 |
| Last Name Of The Provider | BAGWELL |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1771 CURTIS DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | IUKA |
| Zip Code Of The Provider | 388521130 |
| 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 | 146 |
| Number Of Services | 7169 |
| Number Of Medicare Beneficiaries | 479 |
| Total Submitted Charge Amount | 588976 |
| Total Medicare Allowed Amount | 246432.49 |
| Total Medicare Payment Amount | 189953.52 |
| Total Medicare Standardized Payment Amount | 209469.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 755 |
| Number Of Medicare Beneficiaries With Drug Services | 172 |
| Total Drug Submitted ChargeAmount | 13972 |
| Total Drug Medicare AllowedAmount | 7471.37 |
| Total Drug Medicare PaymentAmount | 6287.21 |
| Total Drug Medicare Standardized Payment Amount | 6287.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 133 |
| Number Of Medical Services | 6414 |
| Number Of Medicare Beneficiaries With Medical Services | 479 |
| Total Medical Submitted Charge Amount | 575004 |
| Total Medical Medicare Allowed Amount | 238961.12 |
| Total Medical Medicare Payment Amount | 183666.31 |
| Total Medical Medicare Standardized Payment Amount | 203182.1 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 87 |
| Number Of Beneficiaries Age 65 to 74 | 226 |
| Number Of Beneficiaries Age 75 to 84 | 123 |
| Number Of Beneficiaries Age Greater 84 | 43 |
| Number Of Female Beneficiaries | 290 |
| Number Of Male Beneficiaries | 189 |
| Number Of Non Hispanic White Beneficiaries | 434 |
| Number Of Black or African American Beneficiaries | |
| 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 | 407 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 72 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1381 |