| National Provider Identifier [NPI]: | 1952349912 |
| Last Name Of The Provider | ULLMANN |
| First Name Of The Provider | M |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12234 PANAMA CITY BEACH PKWY |
| Street Address 2 Of The Provider | SUITE C |
| City Of The Provider | PANAMA CITY BEACH |
| Zip Code Of The Provider | 324072700 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 91 |
| Number Of Services | 5749 |
| Number Of Medicare Beneficiaries | 701 |
| Total Submitted Charge Amount | 420429.05 |
| Total Medicare Allowed Amount | 362415.11 |
| Total Medicare Payment Amount | 247427.56 |
| Total Medicare Standardized Payment Amount | 259012.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 498 |
| Number Of Medicare Beneficiaries With Drug Services | 265 |
| Total Drug Submitted ChargeAmount | 3157.08 |
| Total Drug Medicare AllowedAmount | 1907.51 |
| Total Drug Medicare PaymentAmount | 1624.98 |
| Total Drug Medicare Standardized Payment Amount | 1624.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 83 |
| Number Of Medical Services | 5251 |
| Number Of Medicare Beneficiaries With Medical Services | 701 |
| Total Medical Submitted Charge Amount | 417271.97 |
| Total Medical Medicare Allowed Amount | 360507.6 |
| Total Medical Medicare Payment Amount | 245802.58 |
| Total Medical Medicare Standardized Payment Amount | 257387.91 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 430 |
| Number Of Beneficiaries Age 75 to 84 | 152 |
| Number Of Beneficiaries Age Greater 84 | 39 |
| Number Of Female Beneficiaries | 372 |
| Number Of Male Beneficiaries | 329 |
| Number Of Non Hispanic White Beneficiaries | 677 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 651 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 50 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.7602 |