| National Provider Identifier [NPI]: | 1760442636 |
| Last Name Of The Provider | GRAVELYN |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5333 MCAULEY DR |
| Street Address 2 Of The Provider | SUITE 3111 |
| City Of The Provider | YPSILANTI |
| Zip Code Of The Provider | 481971014 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 2036 |
| Number Of Medicare Beneficiaries | 1066 |
| Total Submitted Charge Amount | 416914 |
| Total Medicare Allowed Amount | 234669.07 |
| Total Medicare Payment Amount | 179538.97 |
| Total Medicare Standardized Payment Amount | 179961.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 13 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 386 |
| Total Drug Medicare AllowedAmount | 282.64 |
| Total Drug Medicare PaymentAmount | 276.99 |
| Total Drug Medicare Standardized Payment Amount | 276.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 2023 |
| Number Of Medicare Beneficiaries With Medical Services | 1066 |
| Total Medical Submitted Charge Amount | 416528 |
| Total Medical Medicare Allowed Amount | 234386.43 |
| Total Medical Medicare Payment Amount | 179261.98 |
| Total Medical Medicare Standardized Payment Amount | 179684.88 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 214 |
| Number Of Beneficiaries Age 65 to 74 | 476 |
| Number Of Beneficiaries Age 75 to 84 | 273 |
| Number Of Beneficiaries Age Greater 84 | 103 |
| Number Of Female Beneficiaries | 511 |
| Number Of Male Beneficiaries | 555 |
| Number Of Non Hispanic White Beneficiaries | 931 |
| Number Of Black or African American Beneficiaries | 100 |
| 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 | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 895 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 171 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.646 |