| National Provider Identifier [NPI]: | 1710926399 |
| Last Name Of The Provider | COSTANTINO |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14319 DIX TOLEDO RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTHGATE |
| Zip Code Of The Provider | 481952506 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 1118 |
| Number Of Medicare Beneficiaries | 184 |
| Total Submitted Charge Amount | 92364 |
| Total Medicare Allowed Amount | 63518.94 |
| Total Medicare Payment Amount | 42232.39 |
| Total Medicare Standardized Payment Amount | 42926.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 204 |
| Number Of Medicare Beneficiaries With Drug Services | 83 |
| Total Drug Submitted ChargeAmount | 3139 |
| Total Drug Medicare AllowedAmount | 1975.71 |
| Total Drug Medicare PaymentAmount | 1789.03 |
| Total Drug Medicare Standardized Payment Amount | 1789.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 914 |
| Number Of Medicare Beneficiaries With Medical Services | 184 |
| Total Medical Submitted Charge Amount | 89225 |
| Total Medical Medicare Allowed Amount | 61543.23 |
| Total Medical Medicare Payment Amount | 40443.36 |
| Total Medical Medicare Standardized Payment Amount | 41137.42 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 78 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 103 |
| Number Of Male Beneficiaries | 81 |
| Number Of Non Hispanic White Beneficiaries | 168 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 162 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9933 |