| National Provider Identifier [NPI]: | 1497740260 |
| Last Name Of The Provider | EGHOBAMIEN |
| First Name Of The Provider | DONALD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2322 E 22ND ST |
| Street Address 2 Of The Provider | 360 |
| City Of The Provider | CLEVELAND |
| Zip Code Of The Provider | 441153176 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 1583 |
| Number Of Medicare Beneficiaries | 372 |
| Total Submitted Charge Amount | 175348.75 |
| Total Medicare Allowed Amount | 137397.92 |
| Total Medicare Payment Amount | 100373.96 |
| Total Medicare Standardized Payment Amount | 108373.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 19 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 380 |
| Total Drug Medicare AllowedAmount | 264.5 |
| Total Drug Medicare PaymentAmount | 259.24 |
| Total Drug Medicare Standardized Payment Amount | 259.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 1564 |
| Number Of Medicare Beneficiaries With Medical Services | 372 |
| Total Medical Submitted Charge Amount | 174968.75 |
| Total Medical Medicare Allowed Amount | 137133.42 |
| Total Medical Medicare Payment Amount | 100114.72 |
| Total Medical Medicare Standardized Payment Amount | 108114.21 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 174 |
| Number Of Beneficiaries Age 65 to 74 | 108 |
| Number Of Beneficiaries Age 75 to 84 | 61 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 200 |
| Number Of Male Beneficiaries | 172 |
| Number Of Non Hispanic White Beneficiaries | 111 |
| Number Of Black or African American Beneficiaries | 245 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 118 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 254 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 26 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.8993 |