| National Provider Identifier [NPI]: | 1407832884 |
| Last Name Of The Provider | FAIA |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3535 W 13 MILE RD |
| Street Address 2 Of The Provider | 344 |
| City Of The Provider | ROYAL OAK |
| Zip Code Of The Provider | 480736770 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 10750 |
| Number Of Medicare Beneficiaries | 788 |
| Total Submitted Charge Amount | 3374163 |
| Total Medicare Allowed Amount | 2596622.58 |
| Total Medicare Payment Amount | 1998079.5 |
| Total Medicare Standardized Payment Amount | 1993329.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 4059 |
| Number Of Medicare Beneficiaries With Drug Services | 292 |
| Total Drug Submitted ChargeAmount | 2171943 |
| Total Drug Medicare AllowedAmount | 1880853.99 |
| Total Drug Medicare PaymentAmount | 1465321.25 |
| Total Drug Medicare Standardized Payment Amount | 1465321.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 6691 |
| Number Of Medicare Beneficiaries With Medical Services | 788 |
| Total Medical Submitted Charge Amount | 1202220 |
| Total Medical Medicare Allowed Amount | 715768.59 |
| Total Medical Medicare Payment Amount | 532758.25 |
| Total Medical Medicare Standardized Payment Amount | 528007.84 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 60 |
| Number Of Beneficiaries Age 65 to 74 | 274 |
| Number Of Beneficiaries Age 75 to 84 | 260 |
| Number Of Beneficiaries Age Greater 84 | 194 |
| Number Of Female Beneficiaries | 483 |
| Number Of Male Beneficiaries | 305 |
| Number Of Non Hispanic White Beneficiaries | 725 |
| Number Of Black or African American Beneficiaries | 46 |
| 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 | 714 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 74 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5211 |