| National Provider Identifier [NPI]: | 1316152598 |
| Last Name Of The Provider | CUSTODIO |
| First Name Of The Provider | DON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3232 COOLIDGE HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROYAL OAK |
| Zip Code Of The Provider | 480736854 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 60 |
| Number Of Services | 1185 |
| Number Of Medicare Beneficiaries | 540 |
| Total Submitted Charge Amount | 298256.55 |
| Total Medicare Allowed Amount | 84520.36 |
| Total Medicare Payment Amount | 63850.81 |
| Total Medicare Standardized Payment Amount | 66425.41 |
| 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 | 60 |
| Number Of Medical Services | 1185 |
| Number Of Medicare Beneficiaries With Medical Services | 540 |
| Total Medical Submitted Charge Amount | 298256.55 |
| Total Medical Medicare Allowed Amount | 84520.36 |
| Total Medical Medicare Payment Amount | 63850.81 |
| Total Medical Medicare Standardized Payment Amount | 66425.41 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 210 |
| Number Of Beneficiaries Age 65 to 74 | 144 |
| Number Of Beneficiaries Age 75 to 84 | 102 |
| Number Of Beneficiaries Age Greater 84 | 84 |
| Number Of Female Beneficiaries | 316 |
| Number Of Male Beneficiaries | 224 |
| Number Of Non Hispanic White Beneficiaries | 450 |
| Number Of Black or African American Beneficiaries | 65 |
| 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 | 304 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 236 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7843 |