| National Provider Identifier [NPI]: | 1073518999 |
| Last Name Of The Provider | ULLOM-MINNICH |
| First Name Of The Provider | MARLA |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 EAST PACK |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOUNDRIDGE |
| Zip Code Of The Provider | 67107 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 132 |
| Number Of Services | 2437 |
| Number Of Medicare Beneficiaries | 273 |
| Total Submitted Charge Amount | 226127.5 |
| Total Medicare Allowed Amount | 126611.19 |
| Total Medicare Payment Amount | 94857.32 |
| Total Medicare Standardized Payment Amount | 101018.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 318 |
| Number Of Medicare Beneficiaries With Drug Services | 118 |
| Total Drug Submitted ChargeAmount | 11472 |
| Total Drug Medicare AllowedAmount | 9390.29 |
| Total Drug Medicare PaymentAmount | 8069.89 |
| Total Drug Medicare Standardized Payment Amount | 8069.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 120 |
| Number Of Medical Services | 2119 |
| Number Of Medicare Beneficiaries With Medical Services | 273 |
| Total Medical Submitted Charge Amount | 214655.5 |
| Total Medical Medicare Allowed Amount | 117220.9 |
| Total Medical Medicare Payment Amount | 86787.43 |
| Total Medical Medicare Standardized Payment Amount | 92948.83 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 92 |
| Number Of Beneficiaries Age 75 to 84 | 98 |
| Number Of Beneficiaries Age Greater 84 | 64 |
| Number Of Female Beneficiaries | 221 |
| Number Of Male Beneficiaries | 52 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 228 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 45 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 4 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8869 |