| National Provider Identifier [NPI]: | 1689643496 |
| Last Name Of The Provider | BAZO |
| First Name Of The Provider | CHARBAL |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1641 10TH ST |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | PORT HURON |
| Zip Code Of The Provider | 480605844 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 5541 |
| Number Of Medicare Beneficiaries | 820 |
| Total Submitted Charge Amount | 487866 |
| Total Medicare Allowed Amount | 345415.01 |
| Total Medicare Payment Amount | 226317.57 |
| Total Medicare Standardized Payment Amount | 248565.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 888 |
| Number Of Medicare Beneficiaries With Drug Services | 223 |
| Total Drug Submitted ChargeAmount | 7250 |
| Total Drug Medicare AllowedAmount | 2219.18 |
| Total Drug Medicare PaymentAmount | 1922.29 |
| Total Drug Medicare Standardized Payment Amount | 1922.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 4653 |
| Number Of Medicare Beneficiaries With Medical Services | 820 |
| Total Medical Submitted Charge Amount | 480616 |
| Total Medical Medicare Allowed Amount | 343195.83 |
| Total Medical Medicare Payment Amount | 224395.28 |
| Total Medical Medicare Standardized Payment Amount | 246643.57 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 436 |
| Number Of Beneficiaries Age 65 to 74 | 228 |
| Number Of Beneficiaries Age 75 to 84 | 111 |
| Number Of Beneficiaries Age Greater 84 | 45 |
| Number Of Female Beneficiaries | 406 |
| Number Of Male Beneficiaries | 414 |
| Number Of Non Hispanic White Beneficiaries | 708 |
| Number Of Black or African American Beneficiaries | 69 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 419 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 401 |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 2 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1362 |