| National Provider Identifier [NPI]: | 1992822928 |
| Last Name Of The Provider | HACKETT |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 912 S WASHINGTON AVE |
| Street Address 2 Of The Provider | SUITE 1 |
| City Of The Provider | SAGINAW |
| Zip Code Of The Provider | 486012564 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 107 |
| Number Of Services | 1900 |
| Number Of Medicare Beneficiaries | 521 |
| Total Submitted Charge Amount | 379310 |
| Total Medicare Allowed Amount | 189182.58 |
| Total Medicare Payment Amount | 146316.25 |
| Total Medicare Standardized Payment Amount | 149141.69 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
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| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 154 |
| Number Of Beneficiaries Age 65 to 74 | 165 |
| Number Of Beneficiaries Age 75 to 84 | 130 |
| Number Of Beneficiaries Age Greater 84 | 72 |
| Number Of Female Beneficiaries | 268 |
| Number Of Male Beneficiaries | 253 |
| Number Of Non Hispanic White Beneficiaries | 414 |
| Number Of Black or African American Beneficiaries | 77 |
| 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 | 303 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 218 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 45 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.4558 |