| National Provider Identifier [NPI]: | 1790737070 |
| Last Name Of The Provider | BALESTRERO |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1100 E MICHIGAN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAYLING |
| Zip Code Of The Provider | 497381312 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 211 |
| Number Of Services | 9906 |
| Number Of Medicare Beneficiaries | 4382 |
| Total Submitted Charge Amount | 923285 |
| Total Medicare Allowed Amount | 299171.58 |
| Total Medicare Payment Amount | 230130.74 |
| Total Medicare Standardized Payment Amount | 236791.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 211 |
| Number Of Medical Services | 9906 |
| Number Of Medicare Beneficiaries With Medical Services | 4382 |
| Total Medical Submitted Charge Amount | 923285 |
| Total Medical Medicare Allowed Amount | 299171.58 |
| Total Medical Medicare Payment Amount | 230130.74 |
| Total Medical Medicare Standardized Payment Amount | 236791.32 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 950 |
| Number Of Beneficiaries Age 65 to 74 | 1694 |
| Number Of Beneficiaries Age 75 to 84 | 1288 |
| Number Of Beneficiaries Age Greater 84 | 450 |
| Number Of Female Beneficiaries | 2706 |
| Number Of Male Beneficiaries | 1676 |
| Number Of Non Hispanic White Beneficiaries | 4277 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | 14 |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3288 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1094 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1898 |