| National Provider Identifier [NPI]: | 1750450409 |
| Last Name Of The Provider | VIAL |
| First Name Of The Provider | CLAIRE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | N.P. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4949 COOLIDGE HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROYAL OAK |
| Zip Code Of The Provider | 480731026 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 295 |
| Number Of Medicare Beneficiaries | 59 |
| Total Submitted Charge Amount | 22886 |
| Total Medicare Allowed Amount | 17417.53 |
| Total Medicare Payment Amount | 12668.29 |
| Total Medicare Standardized Payment Amount | 14951.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 28 |
| Total Drug Medicare AllowedAmount | 28 |
| Total Drug Medicare PaymentAmount | 21.86 |
| Total Drug Medicare Standardized Payment Amount | 21.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 271 |
| Number Of Medicare Beneficiaries With Medical Services | 59 |
| Total Medical Submitted Charge Amount | 22858 |
| Total Medical Medicare Allowed Amount | 17389.53 |
| Total Medical Medicare Payment Amount | 12646.43 |
| Total Medical Medicare Standardized Payment Amount | 14929.74 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 12 |
| Number Of Beneficiaries Age 65 to 74 | 36 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 41 |
| Number Of Male Beneficiaries | 18 |
| Number Of Non Hispanic White Beneficiaries | 46 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 24 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.9487 |