| National Provider Identifier [NPI]: | 1205806577 |
| Last Name Of The Provider | BOUDOURIS |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 28595 ORCHARD LAKE RD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | FARMINGTON HILLS |
| Zip Code Of The Provider | 483342977 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 1718 |
| Number Of Medicare Beneficiaries | 1041 |
| Total Submitted Charge Amount | 305230 |
| Total Medicare Allowed Amount | 207606.61 |
| Total Medicare Payment Amount | 152120.32 |
| Total Medicare Standardized Payment Amount | 150668.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 1718 |
| Number Of Medicare Beneficiaries With Medical Services | 1041 |
| Total Medical Submitted Charge Amount | 305230 |
| Total Medical Medicare Allowed Amount | 207606.61 |
| Total Medical Medicare Payment Amount | 152120.32 |
| Total Medical Medicare Standardized Payment Amount | 150668.16 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 235 |
| Number Of Beneficiaries Age 65 to 74 | 323 |
| Number Of Beneficiaries Age 75 to 84 | 277 |
| Number Of Beneficiaries Age Greater 84 | 206 |
| Number Of Female Beneficiaries | 594 |
| Number Of Male Beneficiaries | 447 |
| Number Of Non Hispanic White Beneficiaries | 669 |
| Number Of Black or African American Beneficiaries | 339 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| 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 | 706 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 335 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 48 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 22 |
| Percent Of With Stroke | 29 |
| Average HCC Risk Score Of Beneficiaries | 2.0671 |