| National Provider Identifier [NPI]: | 1639173438 |
| Last Name Of The Provider | BROGAN |
| First Name Of The Provider | THEODORE |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3611 S REED RD |
| Street Address 2 Of The Provider | STE 212 |
| City Of The Provider | KOKOMO |
| Zip Code Of The Provider | 469023806 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 2370 |
| Number Of Medicare Beneficiaries | 576 |
| Total Submitted Charge Amount | 218866 |
| Total Medicare Allowed Amount | 127623.99 |
| Total Medicare Payment Amount | 88157.77 |
| Total Medicare Standardized Payment Amount | 94430.8 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 143 |
| Number Of Medicare Beneficiaries With Drug Services | 85 |
| Total Drug Submitted ChargeAmount | 5725 |
| Total Drug Medicare AllowedAmount | 3642.57 |
| Total Drug Medicare PaymentAmount | 3351.3 |
| Total Drug Medicare Standardized Payment Amount | 3351.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 2227 |
| Number Of Medicare Beneficiaries With Medical Services | 576 |
| Total Medical Submitted Charge Amount | 213141 |
| Total Medical Medicare Allowed Amount | 123981.42 |
| Total Medical Medicare Payment Amount | 84806.47 |
| Total Medical Medicare Standardized Payment Amount | 91079.5 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 266 |
| Number Of Beneficiaries Age 75 to 84 | 191 |
| Number Of Beneficiaries Age Greater 84 | 90 |
| Number Of Female Beneficiaries | 299 |
| Number Of Male Beneficiaries | 277 |
| Number Of Non Hispanic White Beneficiaries | 513 |
| Number Of Black or African American Beneficiaries | 49 |
| 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 | 547 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 29 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9427 |