| National Provider Identifier [NPI]: | 1679674402 |
| Last Name Of The Provider | MITCHELL |
| First Name Of The Provider | JERRY |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3315 N SEMINARY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | GALESBURG |
| Zip Code Of The Provider | 614011251 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 160 |
| Number Of Services | 2045 |
| Number Of Medicare Beneficiaries | 406 |
| Total Submitted Charge Amount | 977122.5 |
| Total Medicare Allowed Amount | 215226.65 |
| Total Medicare Payment Amount | 164702.16 |
| Total Medicare Standardized Payment Amount | 167545.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 801 |
| Total Drug Medicare AllowedAmount | 645.56 |
| Total Drug Medicare PaymentAmount | 632.63 |
| Total Drug Medicare Standardized Payment Amount | 632.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 156 |
| Number Of Medical Services | 2030 |
| Number Of Medicare Beneficiaries With Medical Services | 406 |
| Total Medical Submitted Charge Amount | 976321.5 |
| Total Medical Medicare Allowed Amount | 214581.09 |
| Total Medical Medicare Payment Amount | 164069.53 |
| Total Medical Medicare Standardized Payment Amount | 166912.63 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 69 |
| Number Of Beneficiaries Age 65 to 74 | 157 |
| Number Of Beneficiaries Age 75 to 84 | 115 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 228 |
| Number Of Male Beneficiaries | 178 |
| Number Of Non Hispanic White Beneficiaries | 387 |
| 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 | 297 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 109 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.6659 |