| National Provider Identifier [NPI]: | 1285730705 |
| Last Name Of The Provider | MITCHELL |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3816 S CLEAR CREEK RD |
| Street Address 2 Of The Provider | SUITE E |
| City Of The Provider | KILLEEN |
| Zip Code Of The Provider | 765494400 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 127 |
| Number Of Services | 10272 |
| Number Of Medicare Beneficiaries | 790 |
| Total Submitted Charge Amount | 713146.31 |
| Total Medicare Allowed Amount | 304449.42 |
| Total Medicare Payment Amount | 214102.15 |
| Total Medicare Standardized Payment Amount | 226749.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 991 |
| Number Of Medicare Beneficiaries With Drug Services | 297 |
| Total Drug Submitted ChargeAmount | 30398.23 |
| Total Drug Medicare AllowedAmount | 9039.31 |
| Total Drug Medicare PaymentAmount | 8488.56 |
| Total Drug Medicare Standardized Payment Amount | 8488.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 113 |
| Number Of Medical Services | 9281 |
| Number Of Medicare Beneficiaries With Medical Services | 789 |
| Total Medical Submitted Charge Amount | 682748.08 |
| Total Medical Medicare Allowed Amount | 295410.11 |
| Total Medical Medicare Payment Amount | 205613.59 |
| Total Medical Medicare Standardized Payment Amount | 218261.33 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 211 |
| Number Of Beneficiaries Age 65 to 74 | 414 |
| Number Of Beneficiaries Age 75 to 84 | 128 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 479 |
| Number Of Male Beneficiaries | 311 |
| Number Of Non Hispanic White Beneficiaries | 314 |
| Number Of Black or African American Beneficiaries | 337 |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | 83 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 627 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 163 |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2119 |