| National Provider Identifier [NPI]: | 1104892058 |
| Last Name Of The Provider | HAIDAR |
| First Name Of The Provider | ALI |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1231 PINE GROVE AVE |
| Street Address 2 Of The Provider | SUITE 2B |
| City Of The Provider | PORT HURON |
| Zip Code Of The Provider | 480603500 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 6063 |
| Number Of Medicare Beneficiaries | 1269 |
| Total Submitted Charge Amount | 835501.55 |
| Total Medicare Allowed Amount | 513147.45 |
| Total Medicare Payment Amount | 383851.39 |
| Total Medicare Standardized Payment Amount | 400151.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 390 |
| Number Of Medicare Beneficiaries With Drug Services | 267 |
| Total Drug Submitted ChargeAmount | 8704.55 |
| Total Drug Medicare AllowedAmount | 4064.65 |
| Total Drug Medicare PaymentAmount | 3663.89 |
| Total Drug Medicare Standardized Payment Amount | 3663.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 5673 |
| Number Of Medicare Beneficiaries With Medical Services | 1269 |
| Total Medical Submitted Charge Amount | 826797 |
| Total Medical Medicare Allowed Amount | 509082.8 |
| Total Medical Medicare Payment Amount | 380187.5 |
| Total Medical Medicare Standardized Payment Amount | 396487.8 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 214 |
| Number Of Beneficiaries Age 65 to 74 | 476 |
| Number Of Beneficiaries Age 75 to 84 | 391 |
| Number Of Beneficiaries Age Greater 84 | 188 |
| Number Of Female Beneficiaries | 646 |
| Number Of Male Beneficiaries | 623 |
| Number Of Non Hispanic White Beneficiaries | 1198 |
| Number Of Black or African American Beneficiaries | 29 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 949 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 320 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 23 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 63 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.9212 |