| National Provider Identifier [NPI]: | 1164450201 |
| Last Name Of The Provider | RAPHAELIAN |
| First Name Of The Provider | PAUL |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1150 EAST SHERMAN BLVD |
| Street Address 2 Of The Provider | 2600 |
| City Of The Provider | MUSKEGON |
| Zip Code Of The Provider | 49444 |
| 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 | 40 |
| Number Of Services | 15171 |
| Number Of Medicare Beneficiaries | 903 |
| Total Submitted Charge Amount | 4539312.5 |
| Total Medicare Allowed Amount | 3479246.09 |
| Total Medicare Payment Amount | 2693402.47 |
| Total Medicare Standardized Payment Amount | 2720040.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 7707 |
| Number Of Medicare Beneficiaries With Drug Services | 276 |
| Total Drug Submitted ChargeAmount | 3085027 |
| Total Drug Medicare AllowedAmount | 2682758.91 |
| Total Drug Medicare PaymentAmount | 2103282.08 |
| Total Drug Medicare Standardized Payment Amount | 2103282.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 7464 |
| Number Of Medicare Beneficiaries With Medical Services | 903 |
| Total Medical Submitted Charge Amount | 1454285.5 |
| Total Medical Medicare Allowed Amount | 796487.18 |
| Total Medical Medicare Payment Amount | 590120.39 |
| Total Medical Medicare Standardized Payment Amount | 616758.62 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 97 |
| Number Of Beneficiaries Age 65 to 74 | 252 |
| Number Of Beneficiaries Age 75 to 84 | 282 |
| Number Of Beneficiaries Age Greater 84 | 272 |
| Number Of Female Beneficiaries | 564 |
| Number Of Male Beneficiaries | 339 |
| Number Of Non Hispanic White Beneficiaries | 828 |
| Number Of Black or African American Beneficiaries | 49 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 765 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 138 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.5564 |