| National Provider Identifier [NPI]: | 1134104706 |
| Last Name Of The Provider | WHITE |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 112 JEFFERSON AVE |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 432151702 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 3690 |
| Number Of Medicare Beneficiaries | 414 |
| Total Submitted Charge Amount | 334292.96 |
| Total Medicare Allowed Amount | 191390.58 |
| Total Medicare Payment Amount | 144241.88 |
| Total Medicare Standardized Payment Amount | 153012.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 623 |
| Number Of Medicare Beneficiaries With Drug Services | 153 |
| Total Drug Submitted ChargeAmount | 10672.02 |
| Total Drug Medicare AllowedAmount | 2779.39 |
| Total Drug Medicare PaymentAmount | 2324.62 |
| Total Drug Medicare Standardized Payment Amount | 2324.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 3067 |
| Number Of Medicare Beneficiaries With Medical Services | 414 |
| Total Medical Submitted Charge Amount | 323620.94 |
| Total Medical Medicare Allowed Amount | 188611.19 |
| Total Medical Medicare Payment Amount | 141917.26 |
| Total Medical Medicare Standardized Payment Amount | 150688.37 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 215 |
| Number Of Beneficiaries Age 65 to 74 | 129 |
| Number Of Beneficiaries Age 75 to 84 | 55 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 203 |
| Number Of Male Beneficiaries | 211 |
| Number Of Non Hispanic White Beneficiaries | 62 |
| Number Of Black or African American Beneficiaries | 329 |
| 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 | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 122 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 292 |
| Percent Of With Atrial Fibrillation | 3 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.448 |