| National Provider Identifier [NPI]: | 1053412601 |
| Last Name Of The Provider | FUNDENBERGER |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | CRNA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1209 NW NORTH RIDGE DR STE B |
| Street Address 2 Of The Provider | ANESTHESIA SERVICES OF BLUE SPRINGS |
| City Of The Provider | BLUE SPRINGS |
| Zip Code Of The Provider | 640156320 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | CRNA |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 193 |
| Number Of Medicare Beneficiaries | 185 |
| Total Submitted Charge Amount | 72794 |
| Total Medicare Allowed Amount | 22882.69 |
| Total Medicare Payment Amount | 17889.15 |
| Total Medicare Standardized Payment Amount | 17827.03 |
| 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 | 43 |
| Number Of Medical Services | 193 |
| Number Of Medicare Beneficiaries With Medical Services | 185 |
| Total Medical Submitted Charge Amount | 72794 |
| Total Medical Medicare Allowed Amount | 22882.69 |
| Total Medical Medicare Payment Amount | 17889.15 |
| Total Medical Medicare Standardized Payment Amount | 17827.03 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | 62 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 89 |
| Number Of Male Beneficiaries | 96 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 163 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3875 |