| National Provider Identifier [NPI]: | 1629072699 |
| Last Name Of The Provider | INGRAM |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1602 VERNON RD |
| Street Address 2 Of The Provider | STE 400 |
| City Of The Provider | LAGRANGE |
| Zip Code Of The Provider | 302404100 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 144 |
| Number Of Services | 23280 |
| Number Of Medicare Beneficiaries | 763 |
| Total Submitted Charge Amount | 1461555.7 |
| Total Medicare Allowed Amount | 919961.42 |
| Total Medicare Payment Amount | 758257.87 |
| Total Medicare Standardized Payment Amount | 783819.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 852 |
| Number Of Medicare Beneficiaries With Drug Services | 411 |
| Total Drug Submitted ChargeAmount | 68270 |
| Total Drug Medicare AllowedAmount | 64685.88 |
| Total Drug Medicare PaymentAmount | 63195.56 |
| Total Drug Medicare Standardized Payment Amount | 63195.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 131 |
| Number Of Medical Services | 22428 |
| Number Of Medicare Beneficiaries With Medical Services | 763 |
| Total Medical Submitted Charge Amount | 1393285.7 |
| Total Medical Medicare Allowed Amount | 855275.54 |
| Total Medical Medicare Payment Amount | 695062.31 |
| Total Medical Medicare Standardized Payment Amount | 720624.4 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 132 |
| Number Of Beneficiaries Age 65 to 74 | 250 |
| Number Of Beneficiaries Age 75 to 84 | 265 |
| Number Of Beneficiaries Age Greater 84 | 116 |
| Number Of Female Beneficiaries | 442 |
| Number Of Male Beneficiaries | 321 |
| Number Of Non Hispanic White Beneficiaries | 548 |
| Number Of Black or African American Beneficiaries | 200 |
| 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 | 589 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 174 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 74 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 55 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 2.4261 |