| National Provider Identifier [NPI]: | 1891782066 |
| Last Name Of The Provider | BURRELL |
| First Name Of The Provider | DONNA |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 610 19TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 319011528 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 145 |
| Number Of Services | 4330 |
| Number Of Medicare Beneficiaries | 582 |
| Total Submitted Charge Amount | 363728 |
| Total Medicare Allowed Amount | 200524.86 |
| Total Medicare Payment Amount | 144580.3 |
| Total Medicare Standardized Payment Amount | 152344.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 725 |
| Total Drug Medicare AllowedAmount | 582.45 |
| Total Drug Medicare PaymentAmount | 569.81 |
| Total Drug Medicare Standardized Payment Amount | 569.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 140 |
| Number Of Medical Services | 4308 |
| Number Of Medicare Beneficiaries With Medical Services | 582 |
| Total Medical Submitted Charge Amount | 363003 |
| Total Medical Medicare Allowed Amount | 199942.41 |
| Total Medical Medicare Payment Amount | 144010.49 |
| Total Medical Medicare Standardized Payment Amount | 151774.62 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 66 |
| Number Of Beneficiaries Age 65 to 74 | 230 |
| Number Of Beneficiaries Age 75 to 84 | 191 |
| Number Of Beneficiaries Age Greater 84 | 95 |
| Number Of Female Beneficiaries | 447 |
| Number Of Male Beneficiaries | 135 |
| Number Of Non Hispanic White Beneficiaries | 303 |
| Number Of Black or African American Beneficiaries | 264 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 517 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 65 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.3814 |