| National Provider Identifier [NPI]: | 1437100419 |
| Last Name Of The Provider | INGRAM |
| First Name Of The Provider | JOHNNY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1154 LOGAN SEWELL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | VIDALIA |
| Zip Code Of The Provider | 713733342 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 9609 |
| Number Of Medicare Beneficiaries | 742 |
| Total Submitted Charge Amount | 664234.16 |
| Total Medicare Allowed Amount | 497213.37 |
| Total Medicare Payment Amount | 361511.74 |
| Total Medicare Standardized Payment Amount | 382246.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 2263 |
| Number Of Medicare Beneficiaries With Drug Services | 297 |
| Total Drug Submitted ChargeAmount | 23476.16 |
| Total Drug Medicare AllowedAmount | 5185.36 |
| Total Drug Medicare PaymentAmount | 4853.92 |
| Total Drug Medicare Standardized Payment Amount | 4853.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 7346 |
| Number Of Medicare Beneficiaries With Medical Services | 742 |
| Total Medical Submitted Charge Amount | 640758 |
| Total Medical Medicare Allowed Amount | 492028.01 |
| Total Medical Medicare Payment Amount | 356657.82 |
| Total Medical Medicare Standardized Payment Amount | 377392.29 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 144 |
| Number Of Beneficiaries Age 65 to 74 | 261 |
| Number Of Beneficiaries Age 75 to 84 | 210 |
| Number Of Beneficiaries Age Greater 84 | 127 |
| Number Of Female Beneficiaries | 442 |
| Number Of Male Beneficiaries | 300 |
| Number Of Non Hispanic White Beneficiaries | 536 |
| 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 | 406 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 336 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4315 |