| National Provider Identifier [NPI]: | 1568634293 |
| Last Name Of The Provider | WEINER |
| First Name Of The Provider | MICHELLE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | D.O., MPH |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 21097 NE 27TH CT |
| Street Address 2 Of The Provider | STE 350 |
| City Of The Provider | MIAMI |
| Zip Code Of The Provider | 331801204 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 581 |
| Number Of Medicare Beneficiaries | 80 |
| Total Submitted Charge Amount | 124781.2 |
| Total Medicare Allowed Amount | 16976.73 |
| Total Medicare Payment Amount | 12499.53 |
| Total Medicare Standardized Payment Amount | 11486.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 413 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 9760.2 |
| Total Drug Medicare AllowedAmount | 2245.58 |
| Total Drug Medicare PaymentAmount | 1760.61 |
| Total Drug Medicare Standardized Payment Amount | 1760.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 168 |
| Number Of Medicare Beneficiaries With Medical Services | 80 |
| Total Medical Submitted Charge Amount | 115021 |
| Total Medical Medicare Allowed Amount | 14731.15 |
| Total Medical Medicare Payment Amount | 10738.92 |
| Total Medical Medicare Standardized Payment Amount | 9725.73 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 25 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 41 |
| Number Of Male Beneficiaries | 39 |
| Number Of Non Hispanic White Beneficiaries | 12 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 54 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 12 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 30 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 50 |
| Percent Of With Diabetes | 58 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 20 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.0913 |