| National Provider Identifier [NPI]: | 1356336119 |
| Last Name Of The Provider | ENGBRETSON |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 452 PERKINS EXT |
| Street Address 2 Of The Provider | |
| City Of The Provider | MEMPHIS |
| Zip Code Of The Provider | 381173808 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 672 |
| Number Of Medicare Beneficiaries | 122 |
| Total Submitted Charge Amount | 76626 |
| Total Medicare Allowed Amount | 30916 |
| Total Medicare Payment Amount | 22867.27 |
| Total Medicare Standardized Payment Amount | 24547.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 87 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 624 |
| Total Drug Medicare AllowedAmount | 281.25 |
| Total Drug Medicare PaymentAmount | 252.83 |
| Total Drug Medicare Standardized Payment Amount | 252.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 585 |
| Number Of Medicare Beneficiaries With Medical Services | 122 |
| Total Medical Submitted Charge Amount | 76002 |
| Total Medical Medicare Allowed Amount | 30634.75 |
| Total Medical Medicare Payment Amount | 22614.44 |
| Total Medical Medicare Standardized Payment Amount | 24294.71 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 53 |
| Number Of Beneficiaries Age 75 to 84 | 25 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 72 |
| Number Of Male Beneficiaries | 50 |
| Number Of Non Hispanic White Beneficiaries | 76 |
| 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 | 85 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1026 |