| National Provider Identifier [NPI]: | 1710986955 |
| Last Name Of The Provider | KRIVITSKY |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 44405 WOODWARD AVE |
| Street Address 2 Of The Provider | ST JOSEPH MERCY HOSPITAL |
| City Of The Provider | PONTIAC |
| Zip Code Of The Provider | 48351 |
| 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 | 38 |
| Number Of Services | 1652 |
| Number Of Medicare Beneficiaries | 487 |
| Total Submitted Charge Amount | 159882 |
| Total Medicare Allowed Amount | 120662.55 |
| Total Medicare Payment Amount | 85256.39 |
| Total Medicare Standardized Payment Amount | 84781.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 213 |
| Number Of Medicare Beneficiaries With Drug Services | 135 |
| Total Drug Submitted ChargeAmount | 5480 |
| Total Drug Medicare AllowedAmount | 4500.79 |
| Total Drug Medicare PaymentAmount | 4388.77 |
| Total Drug Medicare Standardized Payment Amount | 4388.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 1439 |
| Number Of Medicare Beneficiaries With Medical Services | 486 |
| Total Medical Submitted Charge Amount | 154402 |
| Total Medical Medicare Allowed Amount | 116161.76 |
| Total Medical Medicare Payment Amount | 80867.62 |
| Total Medical Medicare Standardized Payment Amount | 80392.8 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 115 |
| Number Of Beneficiaries Age 65 to 74 | 201 |
| Number Of Beneficiaries Age 75 to 84 | 115 |
| Number Of Beneficiaries Age Greater 84 | 56 |
| Number Of Female Beneficiaries | 259 |
| Number Of Male Beneficiaries | 228 |
| Number Of Non Hispanic White Beneficiaries | 367 |
| Number Of Black or African American Beneficiaries | 96 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 393 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 94 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3627 |