| National Provider Identifier [NPI]: | 1407820772 |
| Last Name Of The Provider | NILL |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2512 E DUPONT RD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468251675 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 99 |
| Number Of Services | 7311 |
| Number Of Medicare Beneficiaries | 857 |
| Total Submitted Charge Amount | 763177.25 |
| Total Medicare Allowed Amount | 263405.65 |
| Total Medicare Payment Amount | 197595.35 |
| Total Medicare Standardized Payment Amount | 210167.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 2095 |
| Number Of Medicare Beneficiaries With Drug Services | 61 |
| Total Drug Submitted ChargeAmount | 97882.6 |
| Total Drug Medicare AllowedAmount | 27333.52 |
| Total Drug Medicare PaymentAmount | 21283.98 |
| Total Drug Medicare Standardized Payment Amount | 21283.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 5216 |
| Number Of Medicare Beneficiaries With Medical Services | 857 |
| Total Medical Submitted Charge Amount | 665294.65 |
| Total Medical Medicare Allowed Amount | 236072.13 |
| Total Medical Medicare Payment Amount | 176311.37 |
| Total Medical Medicare Standardized Payment Amount | 188883.19 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 327 |
| Number Of Beneficiaries Age 75 to 84 | 326 |
| Number Of Beneficiaries Age Greater 84 | 124 |
| Number Of Female Beneficiaries | 193 |
| Number Of Male Beneficiaries | 664 |
| Number Of Non Hispanic White Beneficiaries | 802 |
| Number Of Black or African American Beneficiaries | 23 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 760 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 97 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.138 |