| National Provider Identifier [NPI]: | 1063424539 |
| Last Name Of The Provider | HAQUE |
| First Name Of The Provider | MOHAMMAD |
| 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 | 100 SUNNYSIDE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SMYRNA |
| Zip Code Of The Provider | 199771752 |
| State Code Of The Provider | DE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 7 |
| Number Of Services | 365 |
| Number Of Medicare Beneficiaries | 45 |
| Total Submitted Charge Amount | 28343.57 |
| Total Medicare Allowed Amount | 21399.44 |
| Total Medicare Payment Amount | 15197.73 |
| Total Medicare Standardized Payment Amount | 15243.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 667.92 |
| Total Drug Medicare AllowedAmount | 285.36 |
| Total Drug Medicare PaymentAmount | 279.6 |
| Total Drug Medicare Standardized Payment Amount | 279.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 6 |
| Number Of Medical Services | 341 |
| Number Of Medicare Beneficiaries With Medical Services | 45 |
| Total Medical Submitted Charge Amount | 27675.65 |
| Total Medical Medicare Allowed Amount | 21114.08 |
| Total Medical Medicare Payment Amount | 14918.13 |
| Total Medical Medicare Standardized Payment Amount | 14964.35 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 13 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 17 |
| Number Of Male Beneficiaries | 28 |
| Number Of Non Hispanic White Beneficiaries | 34 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 24 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.906 |