| National Provider Identifier [NPI]: | 1841275427 |
| Last Name Of The Provider | ADDIEGO |
| First Name Of The Provider | RAFFAELLO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1116 W GANSON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 492024240 |
| 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 | 47 |
| Number Of Services | 13395 |
| Number Of Medicare Beneficiaries | 1287 |
| Total Submitted Charge Amount | 5745045 |
| Total Medicare Allowed Amount | 3147211.77 |
| Total Medicare Payment Amount | 2414916.72 |
| Total Medicare Standardized Payment Amount | 2443250.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 3310 |
| Number Of Medicare Beneficiaries With Drug Services | 262 |
| Total Drug Submitted ChargeAmount | 2614310 |
| Total Drug Medicare AllowedAmount | 2140861.62 |
| Total Drug Medicare PaymentAmount | 1669274.89 |
| Total Drug Medicare Standardized Payment Amount | 1669274.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 10085 |
| Number Of Medicare Beneficiaries With Medical Services | 1287 |
| Total Medical Submitted Charge Amount | 3130735 |
| Total Medical Medicare Allowed Amount | 1006350.15 |
| Total Medical Medicare Payment Amount | 745641.83 |
| Total Medical Medicare Standardized Payment Amount | 773975.35 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 97 |
| Number Of Beneficiaries Age 65 to 74 | 466 |
| Number Of Beneficiaries Age 75 to 84 | 451 |
| Number Of Beneficiaries Age Greater 84 | 273 |
| Number Of Female Beneficiaries | 776 |
| Number Of Male Beneficiaries | 511 |
| Number Of Non Hispanic White Beneficiaries | 1169 |
| Number Of Black or African American Beneficiaries | 71 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1157 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 130 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3842 |