| National Provider Identifier [NPI]: | 1386699643 |
| Last Name Of The Provider | LABENZ |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 77 W. FOREST AVENUE |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | FLAGSTAFF |
| Zip Code Of The Provider | 860011482 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 266 |
| Number Of Services | 11150 |
| Number Of Medicare Beneficiaries | 2577 |
| Total Submitted Charge Amount | 1580078.84 |
| Total Medicare Allowed Amount | 388861.65 |
| Total Medicare Payment Amount | 303463.85 |
| Total Medicare Standardized Payment Amount | 308605.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 6537 |
| Number Of Medicare Beneficiaries With Drug Services | 136 |
| Total Drug Submitted ChargeAmount | 8872.11 |
| Total Drug Medicare AllowedAmount | 2675.05 |
| Total Drug Medicare PaymentAmount | 2081.85 |
| Total Drug Medicare Standardized Payment Amount | 2081.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 258 |
| Number Of Medical Services | 4613 |
| Number Of Medicare Beneficiaries With Medical Services | 2577 |
| Total Medical Submitted Charge Amount | 1571206.73 |
| Total Medical Medicare Allowed Amount | 386186.6 |
| Total Medical Medicare Payment Amount | 301382 |
| Total Medical Medicare Standardized Payment Amount | 306523.36 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 347 |
| Number Of Beneficiaries Age 65 to 74 | 1240 |
| Number Of Beneficiaries Age 75 to 84 | 703 |
| Number Of Beneficiaries Age Greater 84 | 287 |
| Number Of Female Beneficiaries | 1468 |
| Number Of Male Beneficiaries | 1109 |
| Number Of Non Hispanic White Beneficiaries | 1762 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 189 |
| Number Of American Indian Alaska Native Beneficiaries | 549 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1913 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 664 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4234 |