| National Provider Identifier [NPI]: | 1629071709 |
| Last Name Of The Provider | O'DONNELL |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3201 S LOOP 256 |
| Street Address 2 Of The Provider | STE 170 |
| City Of The Provider | PALESTINE |
| Zip Code Of The Provider | 758016901 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 271 |
| Number Of Services | 17438 |
| Number Of Medicare Beneficiaries | 1125 |
| Total Submitted Charge Amount | 1533725.96 |
| Total Medicare Allowed Amount | 586204.03 |
| Total Medicare Payment Amount | 457387.08 |
| Total Medicare Standardized Payment Amount | 485229.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 20 |
| Number Of Drug Services | 1900 |
| Number Of Medicare Beneficiaries With Drug Services | 397 |
| Total Drug Submitted ChargeAmount | 25500.88 |
| Total Drug Medicare AllowedAmount | 17394.66 |
| Total Drug Medicare PaymentAmount | 14759.05 |
| Total Drug Medicare Standardized Payment Amount | 14759.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 251 |
| Number Of Medical Services | 15538 |
| Number Of Medicare Beneficiaries With Medical Services | 1125 |
| Total Medical Submitted Charge Amount | 1508225.08 |
| Total Medical Medicare Allowed Amount | 568809.37 |
| Total Medical Medicare Payment Amount | 442628.03 |
| Total Medical Medicare Standardized Payment Amount | 470470.47 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 128 |
| Number Of Beneficiaries Age 65 to 74 | 455 |
| Number Of Beneficiaries Age 75 to 84 | 364 |
| Number Of Beneficiaries Age Greater 84 | 178 |
| Number Of Female Beneficiaries | 681 |
| Number Of Male Beneficiaries | 444 |
| Number Of Non Hispanic White Beneficiaries | 988 |
| Number Of Black or African American Beneficiaries | 106 |
| 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 | 960 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 165 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.171 |