| National Provider Identifier [NPI]: | 1568452811 |
| Last Name Of The Provider | DOMBROSKE |
| First Name Of The Provider | OLAN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7115 CADE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BROWN CITY |
| Zip Code Of The Provider | 484169778 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 98 |
| Number Of Services | 2520 |
| Number Of Medicare Beneficiaries | 257 |
| Total Submitted Charge Amount | 113508.8 |
| Total Medicare Allowed Amount | 96050.47 |
| Total Medicare Payment Amount | 69178.19 |
| Total Medicare Standardized Payment Amount | 69379.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 310 |
| Number Of Medicare Beneficiaries With Drug Services | 139 |
| Total Drug Submitted ChargeAmount | 3600.3 |
| Total Drug Medicare AllowedAmount | 3030.53 |
| Total Drug Medicare PaymentAmount | 2745.87 |
| Total Drug Medicare Standardized Payment Amount | 2745.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 82 |
| Number Of Medical Services | 2210 |
| Number Of Medicare Beneficiaries With Medical Services | 257 |
| Total Medical Submitted Charge Amount | 109908.5 |
| Total Medical Medicare Allowed Amount | 93019.94 |
| Total Medical Medicare Payment Amount | 66432.32 |
| Total Medical Medicare Standardized Payment Amount | 66634.06 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 106 |
| Number Of Beneficiaries Age 75 to 84 | 88 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 140 |
| Number Of Male Beneficiaries | 117 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 233 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1658 |