| National Provider Identifier [NPI]: | 1114925112 |
| Last Name Of The Provider | WAREHAM |
| First Name Of The Provider | MARSHALL |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5250 FAR HILLS AVE |
| Street Address 2 Of The Provider | SUITE 207 |
| City Of The Provider | DAYTON |
| Zip Code Of The Provider | 454292382 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 2730 |
| Number Of Medicare Beneficiaries | 1344 |
| Total Submitted Charge Amount | 596244 |
| Total Medicare Allowed Amount | 351819.21 |
| Total Medicare Payment Amount | 247408.53 |
| Total Medicare Standardized Payment Amount | 260206.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 2730 |
| Number Of Medicare Beneficiaries With Medical Services | 1344 |
| Total Medical Submitted Charge Amount | 596244 |
| Total Medical Medicare Allowed Amount | 351819.21 |
| Total Medical Medicare Payment Amount | 247408.53 |
| Total Medical Medicare Standardized Payment Amount | 260206.91 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 461 |
| Number Of Beneficiaries Age 75 to 84 | 545 |
| Number Of Beneficiaries Age Greater 84 | 299 |
| Number Of Female Beneficiaries | 829 |
| Number Of Male Beneficiaries | 515 |
| Number Of Non Hispanic White Beneficiaries | 1273 |
| Number Of Black or African American Beneficiaries | 25 |
| Number Of AsianPacific Islander Beneficiaries | 15 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1275 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.056 |