| National Provider Identifier [NPI]: | 1104886662 |
| Last Name Of The Provider | BERGSTROM |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 108 NORTH PARK DR. |
| Street Address 2 Of The Provider | |
| City Of The Provider | FAYETTEVILLE |
| Zip Code Of The Provider | 30214 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 1708 |
| Number Of Medicare Beneficiaries | 495 |
| Total Submitted Charge Amount | 195824 |
| Total Medicare Allowed Amount | 108121.39 |
| Total Medicare Payment Amount | 71296.06 |
| Total Medicare Standardized Payment Amount | 72521.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 65 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 2312 |
| Total Drug Medicare AllowedAmount | 1290.76 |
| Total Drug Medicare PaymentAmount | 1239.15 |
| Total Drug Medicare Standardized Payment Amount | 1239.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 1643 |
| Number Of Medicare Beneficiaries With Medical Services | 495 |
| Total Medical Submitted Charge Amount | 193512 |
| Total Medical Medicare Allowed Amount | 106830.63 |
| Total Medical Medicare Payment Amount | 70056.91 |
| Total Medical Medicare Standardized Payment Amount | 71282.7 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 214 |
| Number Of Beneficiaries Age 75 to 84 | 183 |
| Number Of Beneficiaries Age Greater 84 | 78 |
| Number Of Female Beneficiaries | 259 |
| Number Of Male Beneficiaries | 236 |
| Number Of Non Hispanic White Beneficiaries | 460 |
| Number Of Black or African American Beneficiaries | 23 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 6 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8615 |