| National Provider Identifier [NPI]: | 1649439050 |
| Last Name Of The Provider | DEJENIE |
| First Name Of The Provider | FREAW |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11104 PARKVIEW CIRCLE DR |
| Street Address 2 Of The Provider | SUITE 310 |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468451672 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 693 |
| Number Of Medicare Beneficiaries | 405 |
| Total Submitted Charge Amount | 334613 |
| Total Medicare Allowed Amount | 79696.78 |
| Total Medicare Payment Amount | 59399.95 |
| Total Medicare Standardized Payment Amount | 63696.7 |
| 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 | 30 |
| Number Of Medical Services | 693 |
| Number Of Medicare Beneficiaries With Medical Services | 405 |
| Total Medical Submitted Charge Amount | 334613 |
| Total Medical Medicare Allowed Amount | 79696.78 |
| Total Medical Medicare Payment Amount | 59399.95 |
| Total Medical Medicare Standardized Payment Amount | 63696.7 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 140 |
| Number Of Beneficiaries Age 65 to 74 | 123 |
| Number Of Beneficiaries Age 75 to 84 | 88 |
| Number Of Beneficiaries Age Greater 84 | 54 |
| Number Of Female Beneficiaries | 230 |
| Number Of Male Beneficiaries | 175 |
| Number Of Non Hispanic White Beneficiaries | 317 |
| Number Of Black or African American Beneficiaries | 63 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 246 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 159 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.1161 |