| National Provider Identifier [NPI]: | 1124206685 |
| Last Name Of The Provider | BASIC |
| First Name Of The Provider | EDIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 15855 19 MILE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CLINTON TOWNSHIP |
| Zip Code Of The Provider | 480383504 |
| 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 | 62 |
| Number Of Services | 45929 |
| Number Of Medicare Beneficiaries | 664 |
| Total Submitted Charge Amount | 5220133 |
| Total Medicare Allowed Amount | 1719792.63 |
| Total Medicare Payment Amount | 1334629.9 |
| Total Medicare Standardized Payment Amount | 1434665.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 42405 |
| Number Of Medicare Beneficiaries With Drug Services | 277 |
| Total Drug Submitted ChargeAmount | 48642 |
| Total Drug Medicare AllowedAmount | 11895.53 |
| Total Drug Medicare PaymentAmount | 9301.3 |
| Total Drug Medicare Standardized Payment Amount | 9301.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 3524 |
| Number Of Medicare Beneficiaries With Medical Services | 664 |
| Total Medical Submitted Charge Amount | 5171491 |
| Total Medical Medicare Allowed Amount | 1707897.1 |
| Total Medical Medicare Payment Amount | 1325328.6 |
| Total Medical Medicare Standardized Payment Amount | 1425364.03 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 238 |
| Number Of Beneficiaries Age 65 to 74 | 205 |
| Number Of Beneficiaries Age 75 to 84 | 158 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 313 |
| Number Of Male Beneficiaries | 351 |
| Number Of Non Hispanic White Beneficiaries | 466 |
| Number Of Black or African American Beneficiaries | 130 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 416 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 248 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 61 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 66 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 5.4403 |