| National Provider Identifier [NPI]: | 1326199399 |
| Last Name Of The Provider | BACKERMAN |
| First Name Of The Provider | IVAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 139 12TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | APALACHICOLA |
| Zip Code Of The Provider | 323202110 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 363 |
| Number Of Medicare Beneficiaries | 176 |
| Total Submitted Charge Amount | 12076.45 |
| Total Medicare Allowed Amount | 11478.23 |
| Total Medicare Payment Amount | 10871.79 |
| Total Medicare Standardized Payment Amount | 11478.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 161 |
| Number Of Medicare Beneficiaries With Drug Services | 149 |
| Total Drug Submitted ChargeAmount | 5429.87 |
| Total Drug Medicare AllowedAmount | 5417.27 |
| Total Drug Medicare PaymentAmount | 5182.34 |
| Total Drug Medicare Standardized Payment Amount | 5182.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 202 |
| Number Of Medicare Beneficiaries With Medical Services | 175 |
| Total Medical Submitted Charge Amount | 6646.58 |
| Total Medical Medicare Allowed Amount | 6060.96 |
| Total Medical Medicare Payment Amount | 5689.45 |
| Total Medical Medicare Standardized Payment Amount | 6296.33 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 69 |
| Number Of Beneficiaries Age 75 to 84 | 62 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 107 |
| Number Of Male Beneficiaries | 69 |
| Number Of Non Hispanic White Beneficiaries | 157 |
| 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 | 154 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9881 |