National Provider Identifier [NPI]: |
1265426993 |
Last Name Of The Provider |
MUMMERT |
First Name Of The Provider |
TIMOTHY |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
272 BENEDICT AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
NORWALK |
Zip Code Of The Provider |
448572374 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
23 |
Number Of Services |
1315 |
Number Of Medicare Beneficiaries |
495 |
Total Submitted Charge Amount |
180731 |
Total Medicare Allowed Amount |
113377.37 |
Total Medicare Payment Amount |
87369.67 |
Total Medicare Standardized Payment Amount |
89533.19 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
23 |
Number Of Medical Services |
1315 |
Number Of Medicare Beneficiaries With Medical Services |
495 |
Total Medical Submitted Charge Amount |
180731 |
Total Medical Medicare Allowed Amount |
113377.37 |
Total Medical Medicare Payment Amount |
87369.67 |
Total Medical Medicare Standardized Payment Amount |
89533.19 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
86 |
Number Of Beneficiaries Age 65 to 74 |
147 |
Number Of Beneficiaries Age 75 to 84 |
152 |
Number Of Beneficiaries Age Greater 84 |
110 |
Number Of Female Beneficiaries |
267 |
Number Of Male Beneficiaries |
228 |
Number Of Non Hispanic White Beneficiaries |
471 |
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 |
353 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
142 |
Percent Of With Atrial Fibrillation |
31 |
Percent Of With Alzheimers Disease or Dementia |
18 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
46 |
Percent Of With Chronic Kidney Disease |
47 |
Percent Of With Chronic Obstructive Pulmonary Disease |
43 |
Percent Of With Depression |
38 |
Percent Of With Diabetes |
47 |
Percent Of With Hyperlipidemia |
66 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
57 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
18 |
Percent Of With Stroke |
16 |
Average HCC Risk Score Of Beneficiaries |
2.475 |