| National Provider Identifier [NPI]: | 1386611457 |
| Last Name Of The Provider | EBERSOLE-ROBINSON |
| First Name Of The Provider | MAIKO |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD MPH |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4810 STATE AVE |
| Street Address 2 Of The Provider | STATE AVENUE HEALTH CARE |
| City Of The Provider | KANSAS CITY |
| Zip Code Of The Provider | 661021748 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 845 |
| Number Of Medicare Beneficiaries | 165 |
| Total Submitted Charge Amount | 71720 |
| Total Medicare Allowed Amount | 47015.07 |
| Total Medicare Payment Amount | 32797 |
| Total Medicare Standardized Payment Amount | 35205.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 128 |
| Number Of Medicare Beneficiaries With Drug Services | 67 |
| Total Drug Submitted ChargeAmount | 2531 |
| Total Drug Medicare AllowedAmount | 1552.64 |
| Total Drug Medicare PaymentAmount | 1408.84 |
| Total Drug Medicare Standardized Payment Amount | 1408.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 717 |
| Number Of Medicare Beneficiaries With Medical Services | 165 |
| Total Medical Submitted Charge Amount | 69189 |
| Total Medical Medicare Allowed Amount | 45462.43 |
| Total Medical Medicare Payment Amount | 31388.16 |
| Total Medical Medicare Standardized Payment Amount | 33796.71 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 67 |
| Number Of Beneficiaries Age 65 to 74 | 63 |
| Number Of Beneficiaries Age 75 to 84 | 23 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 122 |
| Number Of Male Beneficiaries | 43 |
| Number Of Non Hispanic White Beneficiaries | 40 |
| Number Of Black or African American Beneficiaries | 111 |
| 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 | 94 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 71 |
| 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 | 16 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1862 |