| National Provider Identifier [NPI]: | 1043262447 |
| Last Name Of The Provider | EBY |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11104 PARKVIEW CIRCLE DR |
| Street Address 2 Of The Provider | ENTRANCE 11, SUITE 330 |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 46845 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 5377 |
| Number Of Medicare Beneficiaries | 782 |
| Total Submitted Charge Amount | 635864 |
| Total Medicare Allowed Amount | 299491.94 |
| Total Medicare Payment Amount | 226174.41 |
| Total Medicare Standardized Payment Amount | 237212.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2778 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 18001 |
| Total Drug Medicare AllowedAmount | 10370.16 |
| Total Drug Medicare PaymentAmount | 7836 |
| Total Drug Medicare Standardized Payment Amount | 7836 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 2599 |
| Number Of Medicare Beneficiaries With Medical Services | 782 |
| Total Medical Submitted Charge Amount | 617863 |
| Total Medical Medicare Allowed Amount | 289121.78 |
| Total Medical Medicare Payment Amount | 218338.41 |
| Total Medical Medicare Standardized Payment Amount | 229376.07 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 257 |
| Number Of Beneficiaries Age 65 to 74 | 243 |
| Number Of Beneficiaries Age 75 to 84 | 202 |
| Number Of Beneficiaries Age Greater 84 | 80 |
| Number Of Female Beneficiaries | 387 |
| Number Of Male Beneficiaries | 395 |
| Number Of Non Hispanic White Beneficiaries | 652 |
| Number Of Black or African American Beneficiaries | 85 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 490 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 292 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 55 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 65 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 4.7843 |