| National Provider Identifier [NPI]: | 1497031967 |
| Last Name Of The Provider | FOMBY |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10601 QUIVIRA RD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | OVERLAND PARK |
| Zip Code Of The Provider | 662152310 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 684 |
| Number Of Medicare Beneficiaries | 191 |
| Total Submitted Charge Amount | 79309 |
| Total Medicare Allowed Amount | 34278.94 |
| Total Medicare Payment Amount | 27262.07 |
| Total Medicare Standardized Payment Amount | 28870.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 47 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 6509 |
| Total Drug Medicare AllowedAmount | 2496.9 |
| Total Drug Medicare PaymentAmount | 2439.91 |
| Total Drug Medicare Standardized Payment Amount | 2439.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 637 |
| Number Of Medicare Beneficiaries With Medical Services | 191 |
| Total Medical Submitted Charge Amount | 72800 |
| Total Medical Medicare Allowed Amount | 31782.04 |
| Total Medical Medicare Payment Amount | 24822.16 |
| Total Medical Medicare Standardized Payment Amount | 26431.06 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 83 |
| Number Of Beneficiaries Age 75 to 84 | 63 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 108 |
| Number Of Male Beneficiaries | 83 |
| 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 | 177 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0289 |