| National Provider Identifier [NPI]: | 1710054283 |
| Last Name Of The Provider | GROOM |
| First Name Of The Provider | CORWIN |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 707 N 7TH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | POCATELLO |
| Zip Code Of The Provider | 832015796 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 583 |
| Number Of Medicare Beneficiaries | 187 |
| Total Submitted Charge Amount | 77332 |
| Total Medicare Allowed Amount | 34062.41 |
| Total Medicare Payment Amount | 22457.46 |
| Total Medicare Standardized Payment Amount | 25263.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 32 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 702 |
| Total Drug Medicare AllowedAmount | 617.1 |
| Total Drug Medicare PaymentAmount | 596.72 |
| Total Drug Medicare Standardized Payment Amount | 596.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 551 |
| Number Of Medicare Beneficiaries With Medical Services | 187 |
| Total Medical Submitted Charge Amount | 76630 |
| Total Medical Medicare Allowed Amount | 33445.31 |
| Total Medical Medicare Payment Amount | 21860.74 |
| Total Medical Medicare Standardized Payment Amount | 24666.79 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 57 |
| Number Of Beneficiaries Age 75 to 84 | 63 |
| Number Of Beneficiaries Age Greater 84 | 35 |
| Number Of Female Beneficiaries | 101 |
| Number Of Male Beneficiaries | 86 |
| Number Of Non Hispanic White Beneficiaries | 165 |
| 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 | 132 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 55 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1609 |