| National Provider Identifier [NPI]: | 1962574285 |
| Last Name Of The Provider | GREEN |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1937 M 119 |
| Street Address 2 Of The Provider | |
| City Of The Provider | PETOSKEY |
| Zip Code Of The Provider | 497708913 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 10596 |
| Number Of Medicare Beneficiaries | 1287 |
| Total Submitted Charge Amount | 1022037.82 |
| Total Medicare Allowed Amount | 454766.77 |
| Total Medicare Payment Amount | 326785.27 |
| Total Medicare Standardized Payment Amount | 407543.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 1388 |
| Number Of Medicare Beneficiaries With Drug Services | 295 |
| Total Drug Submitted ChargeAmount | 15022.44 |
| Total Drug Medicare AllowedAmount | 3512.9 |
| Total Drug Medicare PaymentAmount | 2768.07 |
| Total Drug Medicare Standardized Payment Amount | 2768.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 9208 |
| Number Of Medicare Beneficiaries With Medical Services | 1287 |
| Total Medical Submitted Charge Amount | 1007015.38 |
| Total Medical Medicare Allowed Amount | 451253.87 |
| Total Medical Medicare Payment Amount | 324017.2 |
| Total Medical Medicare Standardized Payment Amount | 404774.98 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 173 |
| Number Of Beneficiaries Age 65 to 74 | 593 |
| Number Of Beneficiaries Age 75 to 84 | 389 |
| Number Of Beneficiaries Age Greater 84 | 132 |
| Number Of Female Beneficiaries | 646 |
| Number Of Male Beneficiaries | 641 |
| Number Of Non Hispanic White Beneficiaries | 1270 |
| 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 | 1085 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 202 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9615 |