| National Provider Identifier [NPI]: | 1639247372 |
| Last Name Of The Provider | TAHA |
| First Name Of The Provider | MANUEL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | HENRY FORD HEALTH SYSTEM |
| Street Address 2 Of The Provider | 2799 WEST GRAND BOULEVARD |
| City Of The Provider | DETROIT |
| Zip Code Of The Provider | 48202 |
| 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 | 72 |
| Number Of Services | 40124 |
| Number Of Medicare Beneficiaries | 20929 |
| Total Submitted Charge Amount | 724207.79 |
| Total Medicare Allowed Amount | 605269.66 |
| Total Medicare Payment Amount | 447597.74 |
| Total Medicare Standardized Payment Amount | 431464.29 |
| 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 | 72 |
| Number Of Medical Services | 40124 |
| Number Of Medicare Beneficiaries With Medical Services | 20929 |
| Total Medical Submitted Charge Amount | 724207.79 |
| Total Medical Medicare Allowed Amount | 605269.66 |
| Total Medical Medicare Payment Amount | 447597.74 |
| Total Medical Medicare Standardized Payment Amount | 431464.29 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 5011 |
| Number Of Beneficiaries Age 65 to 74 | 4646 |
| Number Of Beneficiaries Age 75 to 84 | 4991 |
| Number Of Beneficiaries Age Greater 84 | 6281 |
| Number Of Female Beneficiaries | 13647 |
| Number Of Male Beneficiaries | 7282 |
| Number Of Non Hispanic White Beneficiaries | 14013 |
| Number Of Black or African American Beneficiaries | 5011 |
| Number Of AsianPacific Islander Beneficiaries | 324 |
| Number Of Hispanic Beneficiaries | 1398 |
| Number Of American Indian Alaska Native Beneficiaries | 23 |
| Number Of Beneficiaries With Race Not Else where Classified | 160 |
| Number Of Beneficiaries With Medicare Only Entitlement | 9182 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11747 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 45 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 55 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 69 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.3463 |