| National Provider Identifier [NPI]: | 1134211931 |
| Last Name Of The Provider | HENRY |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 581 LAKEWOOD LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | MARQUETTE |
| Zip Code Of The Provider | 498559544 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 98 |
| Number Of Services | 2283 |
| Number Of Medicare Beneficiaries | 1705 |
| Total Submitted Charge Amount | 259640 |
| Total Medicare Allowed Amount | 65315.61 |
| Total Medicare Payment Amount | 54030.11 |
| Total Medicare Standardized Payment Amount | 55463.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 98 |
| Number Of Medical Services | 2283 |
| Number Of Medicare Beneficiaries With Medical Services | 1705 |
| Total Medical Submitted Charge Amount | 259640 |
| Total Medical Medicare Allowed Amount | 65315.61 |
| Total Medical Medicare Payment Amount | 54030.11 |
| Total Medical Medicare Standardized Payment Amount | 55463.67 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 312 |
| Number Of Beneficiaries Age 65 to 74 | 636 |
| Number Of Beneficiaries Age 75 to 84 | 483 |
| Number Of Beneficiaries Age Greater 84 | 274 |
| Number Of Female Beneficiaries | 1132 |
| Number Of Male Beneficiaries | 573 |
| Number Of Non Hispanic White Beneficiaries | 1209 |
| Number Of Black or African American Beneficiaries | 248 |
| Number Of AsianPacific Islander Beneficiaries | 27 |
| Number Of Hispanic Beneficiaries | 192 |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1126 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 579 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.8759 |