| National Provider Identifier [NPI]: | 1093796690 |
| Last Name Of The Provider | MONTGOMERY |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 408 CLARK ST NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CULLMAN |
| Zip Code Of The Provider | 350551953 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 84 |
| Number Of Services | 5115 |
| Number Of Medicare Beneficiaries | 660 |
| Total Submitted Charge Amount | 243837 |
| Total Medicare Allowed Amount | 188622.61 |
| Total Medicare Payment Amount | 129837.38 |
| Total Medicare Standardized Payment Amount | 144377.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 1370 |
| Number Of Medicare Beneficiaries With Drug Services | 205 |
| Total Drug Submitted ChargeAmount | 20405 |
| Total Drug Medicare AllowedAmount | 13855.42 |
| Total Drug Medicare PaymentAmount | 11220.36 |
| Total Drug Medicare Standardized Payment Amount | 11220.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 3745 |
| Number Of Medicare Beneficiaries With Medical Services | 660 |
| Total Medical Submitted Charge Amount | 223432 |
| Total Medical Medicare Allowed Amount | 174767.19 |
| Total Medical Medicare Payment Amount | 118617.02 |
| Total Medical Medicare Standardized Payment Amount | 133157.6 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 100 |
| Number Of Beneficiaries Age 65 to 74 | 273 |
| Number Of Beneficiaries Age 75 to 84 | 209 |
| Number Of Beneficiaries Age Greater 84 | 78 |
| Number Of Female Beneficiaries | 379 |
| Number Of Male Beneficiaries | 281 |
| 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 | 505 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 155 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1364 |