| National Provider Identifier [NPI]: | 1598783128 |
| Last Name Of The Provider | BAGWELL |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1301 W 38TH ST |
| Street Address 2 Of The Provider | SUITE 403 |
| City Of The Provider | AUSTIN |
| Zip Code Of The Provider | 787051000 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 11211 |
| Number Of Medicare Beneficiaries | 229 |
| Total Submitted Charge Amount | 697630.5 |
| Total Medicare Allowed Amount | 240507.31 |
| Total Medicare Payment Amount | 186740 |
| Total Medicare Standardized Payment Amount | 184769.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 9811 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 448453.5 |
| Total Drug Medicare AllowedAmount | 118190.3 |
| Total Drug Medicare PaymentAmount | 92475.2 |
| Total Drug Medicare Standardized Payment Amount | 92475.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 1400 |
| Number Of Medicare Beneficiaries With Medical Services | 229 |
| Total Medical Submitted Charge Amount | 249177 |
| Total Medical Medicare Allowed Amount | 122317.01 |
| Total Medical Medicare Payment Amount | 94264.8 |
| Total Medical Medicare Standardized Payment Amount | 92294.3 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 64 |
| Number Of Beneficiaries Age 65 to 74 | 91 |
| Number Of Beneficiaries Age 75 to 84 | 57 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 129 |
| Number Of Non Hispanic White Beneficiaries | 169 |
| Number Of Black or African American Beneficiaries | 34 |
| 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 | 179 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 50 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 55 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.7615 |