| National Provider Identifier [NPI]: | 1639106099 |
| Last Name Of The Provider | DWINELL |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 407 S SCHWARTZ AVE |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | FARMINGTON |
| Zip Code Of The Provider | 874015925 |
| State Code Of The Provider | NM |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 2098 |
| Number Of Medicare Beneficiaries | 605 |
| Total Submitted Charge Amount | 366933.01 |
| Total Medicare Allowed Amount | 186417.56 |
| Total Medicare Payment Amount | 139885.39 |
| Total Medicare Standardized Payment Amount | 146793.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 159 |
| Number Of Medicare Beneficiaries With Drug Services | 139 |
| Total Drug Submitted ChargeAmount | 13615.01 |
| Total Drug Medicare AllowedAmount | 7342.67 |
| Total Drug Medicare PaymentAmount | 7195.52 |
| Total Drug Medicare Standardized Payment Amount | 7195.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 1939 |
| Number Of Medicare Beneficiaries With Medical Services | 605 |
| Total Medical Submitted Charge Amount | 353318 |
| Total Medical Medicare Allowed Amount | 179074.89 |
| Total Medical Medicare Payment Amount | 132689.87 |
| Total Medical Medicare Standardized Payment Amount | 139598.33 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 108 |
| Number Of Beneficiaries Age 65 to 74 | 218 |
| Number Of Beneficiaries Age 75 to 84 | 196 |
| Number Of Beneficiaries Age Greater 84 | 83 |
| Number Of Female Beneficiaries | 339 |
| Number Of Male Beneficiaries | 266 |
| Number Of Non Hispanic White Beneficiaries | 461 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 74 |
| Number Of American Indian Alaska Native Beneficiaries | 59 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 443 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 162 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3057 |