| National Provider Identifier [NPI]: | 1730292079 |
| Last Name Of The Provider | FICI |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 18200 10 MILE RD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | EASTPOINTE |
| Zip Code Of The Provider | 48021 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 1613 |
| Number Of Medicare Beneficiaries | 158 |
| Total Submitted Charge Amount | 103181.01 |
| Total Medicare Allowed Amount | 71856.14 |
| Total Medicare Payment Amount | 50009.68 |
| Total Medicare Standardized Payment Amount | 48783.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 98 |
| Number Of Medicare Beneficiaries With Drug Services | 90 |
| Total Drug Submitted ChargeAmount | 3320 |
| Total Drug Medicare AllowedAmount | 1283.93 |
| Total Drug Medicare PaymentAmount | 1232.75 |
| Total Drug Medicare Standardized Payment Amount | 1232.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 1515 |
| Number Of Medicare Beneficiaries With Medical Services | 158 |
| Total Medical Submitted Charge Amount | 99861.01 |
| Total Medical Medicare Allowed Amount | 70572.21 |
| Total Medical Medicare Payment Amount | 48776.93 |
| Total Medical Medicare Standardized Payment Amount | 47550.83 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | 45 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 84 |
| Number Of Male Beneficiaries | 74 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.124 |