| National Provider Identifier [NPI]: | 1063676286 |
| Last Name Of The Provider | HAOUILOU |
| First Name Of The Provider | JIMMY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 29519 HARPER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT CLAIR SHORES |
| Zip Code Of The Provider | 480811275 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Vascular Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 172 |
| Number Of Services | 3041 |
| Number Of Medicare Beneficiaries | 1115 |
| Total Submitted Charge Amount | 748007 |
| Total Medicare Allowed Amount | 346611.74 |
| Total Medicare Payment Amount | 267968.13 |
| Total Medicare Standardized Payment Amount | 254080.65 |
| 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 | 172 |
| Number Of Medical Services | 3041 |
| Number Of Medicare Beneficiaries With Medical Services | 1115 |
| Total Medical Submitted Charge Amount | 748007 |
| Total Medical Medicare Allowed Amount | 346611.74 |
| Total Medical Medicare Payment Amount | 267968.13 |
| Total Medical Medicare Standardized Payment Amount | 254080.65 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 260 |
| Number Of Beneficiaries Age 65 to 74 | 338 |
| Number Of Beneficiaries Age 75 to 84 | 314 |
| Number Of Beneficiaries Age Greater 84 | 203 |
| Number Of Female Beneficiaries | 632 |
| Number Of Male Beneficiaries | 483 |
| Number Of Non Hispanic White Beneficiaries | 573 |
| Number Of Black or African American Beneficiaries | 518 |
| 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 | 728 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 387 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 56 |
| Percent Of With Chronic Kidney Disease | 60 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 58 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 73 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 25 |
| Average HCC Risk Score Of Beneficiaries | 3.2536 |