| National Provider Identifier [NPI]: | 1295733822 |
| Last Name Of The Provider | GOVER-MENDEZ |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1521 S STAPLES ST |
| Street Address 2 Of The Provider | STES 104, 301 & 304 |
| City Of The Provider | CORPUS CHRISTI |
| Zip Code Of The Provider | 784043150 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 244 |
| Number Of Services | 22848 |
| Number Of Medicare Beneficiaries | 2069 |
| Total Submitted Charge Amount | 1401854.06 |
| Total Medicare Allowed Amount | 427533 |
| Total Medicare Payment Amount | 327334.29 |
| Total Medicare Standardized Payment Amount | 347645.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 19554 |
| Number Of Medicare Beneficiaries With Drug Services | 328 |
| Total Drug Submitted ChargeAmount | 17260.36 |
| Total Drug Medicare AllowedAmount | 8147.87 |
| Total Drug Medicare PaymentAmount | 6342.42 |
| Total Drug Medicare Standardized Payment Amount | 6342.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 237 |
| Number Of Medical Services | 3294 |
| Number Of Medicare Beneficiaries With Medical Services | 2068 |
| Total Medical Submitted Charge Amount | 1384593.7 |
| Total Medical Medicare Allowed Amount | 419385.13 |
| Total Medical Medicare Payment Amount | 320991.87 |
| Total Medical Medicare Standardized Payment Amount | 341303.3 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 357 |
| Number Of Beneficiaries Age 65 to 74 | 818 |
| Number Of Beneficiaries Age 75 to 84 | 630 |
| Number Of Beneficiaries Age Greater 84 | 264 |
| Number Of Female Beneficiaries | 1224 |
| Number Of Male Beneficiaries | 845 |
| Number Of Non Hispanic White Beneficiaries | 1263 |
| Number Of Black or African American Beneficiaries | 47 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 733 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1558 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 511 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7755 |