| National Provider Identifier [NPI]: | 1669437844 |
| Last Name Of The Provider | EISENTROUT |
| First Name Of The Provider | TAMMY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4048 DRESSLER RD NW |
| Street Address 2 Of The Provider | SUITE 203 |
| City Of The Provider | CANTON |
| Zip Code Of The Provider | 447182784 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 736 |
| Number Of Medicare Beneficiaries | 81 |
| Total Submitted Charge Amount | 35441 |
| Total Medicare Allowed Amount | 27744.69 |
| Total Medicare Payment Amount | 19503.57 |
| Total Medicare Standardized Payment Amount | 21057.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 108 |
| Number Of Medicare Beneficiaries With Drug Services | 36 |
| Total Drug Submitted ChargeAmount | 4385 |
| Total Drug Medicare AllowedAmount | 2464.64 |
| Total Drug Medicare PaymentAmount | 2240.28 |
| Total Drug Medicare Standardized Payment Amount | 2240.28 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 628 |
| Number Of Medicare Beneficiaries With Medical Services | 81 |
| Total Medical Submitted Charge Amount | 31056 |
| Total Medical Medicare Allowed Amount | 25280.05 |
| Total Medical Medicare Payment Amount | 17263.29 |
| Total Medical Medicare Standardized Payment Amount | 18817.24 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 30 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 56 |
| Number Of Male Beneficiaries | 25 |
| 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 | 46 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 35 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.038 |