| National Provider Identifier [NPI]: | 1619934320 |
| Last Name Of The Provider | ODUMODU |
| First Name Of The Provider | NWANNEKA |
| Middle Initial Of The Provider | U |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 15330 E 10 MILE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | EASTPOINTE |
| Zip Code Of The Provider | 480211012 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 886 |
| Number Of Medicare Beneficiaries | 115 |
| Total Submitted Charge Amount | 90600 |
| Total Medicare Allowed Amount | 78978.23 |
| Total Medicare Payment Amount | 62940.51 |
| Total Medicare Standardized Payment Amount | 63288.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 550 |
| Total Drug Medicare AllowedAmount | 310.2 |
| Total Drug Medicare PaymentAmount | 304.04 |
| Total Drug Medicare Standardized Payment Amount | 304.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 864 |
| Number Of Medicare Beneficiaries With Medical Services | 115 |
| Total Medical Submitted Charge Amount | 90050 |
| Total Medical Medicare Allowed Amount | 78668.03 |
| Total Medical Medicare Payment Amount | 62636.47 |
| Total Medical Medicare Standardized Payment Amount | 62984.43 |
| Average Age Of Beneficiaries | 55 |
| Number Of Beneficiaries Age Less65 | 93 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 74 |
| Number Of Male Beneficiaries | 41 |
| Number Of Non Hispanic White Beneficiaries | 64 |
| 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 | 38 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 77 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4196 |