| National Provider Identifier [NPI]: | 1508974650 |
| Last Name Of The Provider | CHURCH |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 727 FAIRLAWN CT |
| Street Address 2 Of The Provider | |
| City Of The Provider | MARCO ISLAND |
| Zip Code Of The Provider | 341453850 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 163 |
| Number Of Services | 5800 |
| Number Of Medicare Beneficiaries | 2787 |
| Total Submitted Charge Amount | 275039.2 |
| Total Medicare Allowed Amount | 133412.35 |
| Total Medicare Payment Amount | 100627.79 |
| Total Medicare Standardized Payment Amount | 105417.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1940 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 2283.2 |
| Total Drug Medicare AllowedAmount | 739.73 |
| Total Drug Medicare PaymentAmount | 555.18 |
| Total Drug Medicare Standardized Payment Amount | 555.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 161 |
| Number Of Medical Services | 3860 |
| Number Of Medicare Beneficiaries With Medical Services | 2787 |
| Total Medical Submitted Charge Amount | 272756 |
| Total Medical Medicare Allowed Amount | 132672.62 |
| Total Medical Medicare Payment Amount | 100072.61 |
| Total Medical Medicare Standardized Payment Amount | 104862.04 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 733 |
| Number Of Beneficiaries Age 65 to 74 | 911 |
| Number Of Beneficiaries Age 75 to 84 | 717 |
| Number Of Beneficiaries Age Greater 84 | 426 |
| Number Of Female Beneficiaries | 1604 |
| Number Of Male Beneficiaries | 1183 |
| Number Of Non Hispanic White Beneficiaries | 2244 |
| Number Of Black or African American Beneficiaries | 382 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 117 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1820 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 967 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.8527 |