| National Provider Identifier [NPI]: | 1366485005 |
| Last Name Of The Provider | MICHELENA |
| First Name Of The Provider | MIA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1540 LAKE LANSING RD |
| Street Address 2 Of The Provider | STE 102 |
| City Of The Provider | LANSING |
| Zip Code Of The Provider | 489123756 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 2293 |
| Number Of Medicare Beneficiaries | 580 |
| Total Submitted Charge Amount | 239513.05 |
| Total Medicare Allowed Amount | 156464.17 |
| Total Medicare Payment Amount | 114097.11 |
| Total Medicare Standardized Payment Amount | 118420.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 348 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 6522.8 |
| Total Drug Medicare AllowedAmount | 5283.21 |
| Total Drug Medicare PaymentAmount | 4244.7 |
| Total Drug Medicare Standardized Payment Amount | 4244.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 1945 |
| Number Of Medicare Beneficiaries With Medical Services | 580 |
| Total Medical Submitted Charge Amount | 232990.25 |
| Total Medical Medicare Allowed Amount | 151180.96 |
| Total Medical Medicare Payment Amount | 109852.41 |
| Total Medical Medicare Standardized Payment Amount | 114176.04 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 83 |
| Number Of Beneficiaries Age 65 to 74 | 216 |
| Number Of Beneficiaries Age 75 to 84 | 177 |
| Number Of Beneficiaries Age Greater 84 | 104 |
| Number Of Female Beneficiaries | 391 |
| Number Of Male Beneficiaries | 189 |
| Number Of Non Hispanic White Beneficiaries | 503 |
| Number Of Black or African American Beneficiaries | 50 |
| 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 | 484 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 96 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6266 |