| National Provider Identifier [NPI]: | 1568480861 |
| Last Name Of The Provider | MIENK |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10785 S GRANT AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CLARE |
| Zip Code Of The Provider | 486179418 |
| 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 | 64 |
| Number Of Services | 6060 |
| Number Of Medicare Beneficiaries | 1881 |
| Total Submitted Charge Amount | 427272 |
| Total Medicare Allowed Amount | 269673.98 |
| Total Medicare Payment Amount | 202322.03 |
| Total Medicare Standardized Payment Amount | 210240.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 459 |
| Number Of Medicare Beneficiaries With Drug Services | 402 |
| Total Drug Submitted ChargeAmount | 15495 |
| Total Drug Medicare AllowedAmount | 8096.31 |
| Total Drug Medicare PaymentAmount | 7899.66 |
| Total Drug Medicare Standardized Payment Amount | 7899.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 5601 |
| Number Of Medicare Beneficiaries With Medical Services | 1881 |
| Total Medical Submitted Charge Amount | 411777 |
| Total Medical Medicare Allowed Amount | 261577.67 |
| Total Medical Medicare Payment Amount | 194422.37 |
| Total Medical Medicare Standardized Payment Amount | 202341.29 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 357 |
| Number Of Beneficiaries Age 65 to 74 | 743 |
| Number Of Beneficiaries Age 75 to 84 | 560 |
| Number Of Beneficiaries Age Greater 84 | 221 |
| Number Of Female Beneficiaries | 970 |
| Number Of Male Beneficiaries | 911 |
| Number Of Non Hispanic White Beneficiaries | 1839 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1412 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 469 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3666 |