| National Provider Identifier [NPI]: | 1952323016 |
| Last Name Of The Provider | ENGELMANN |
| First Name Of The Provider | THEODORE |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6770 DIXIE HWY |
| Street Address 2 Of The Provider | SUITE 202 |
| City Of The Provider | CLARKSTON |
| Zip Code Of The Provider | 483462087 |
| 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 | 55 |
| Number Of Services | 2039 |
| Number Of Medicare Beneficiaries | 168 |
| Total Submitted Charge Amount | 132662.99 |
| Total Medicare Allowed Amount | 99371.1 |
| Total Medicare Payment Amount | 69212.49 |
| Total Medicare Standardized Payment Amount | 67316.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 195 |
| Number Of Medicare Beneficiaries With Drug Services | 65 |
| Total Drug Submitted ChargeAmount | 3940 |
| Total Drug Medicare AllowedAmount | 262.52 |
| Total Drug Medicare PaymentAmount | 179.06 |
| Total Drug Medicare Standardized Payment Amount | 179.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 1844 |
| Number Of Medicare Beneficiaries With Medical Services | 168 |
| Total Medical Submitted Charge Amount | 128722.99 |
| Total Medical Medicare Allowed Amount | 99108.58 |
| Total Medical Medicare Payment Amount | 69033.43 |
| Total Medical Medicare Standardized Payment Amount | 67137.08 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 94 |
| Number Of Beneficiaries Age 65 to 74 | 45 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 68 |
| 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 | 108 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 60 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.284 |