| National Provider Identifier [NPI]: | 1124102405 |
| Last Name Of The Provider | HAQUE |
| First Name Of The Provider | ANGIE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3465 MACON RD |
| Street Address 2 Of The Provider | STE D |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 319072582 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 1051 |
| Number Of Medicare Beneficiaries | 638 |
| Total Submitted Charge Amount | 81843.5 |
| Total Medicare Allowed Amount | 55262.13 |
| Total Medicare Payment Amount | 33493.96 |
| Total Medicare Standardized Payment Amount | 36185.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 156 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 1555 |
| Total Drug Medicare AllowedAmount | 158 |
| Total Drug Medicare PaymentAmount | 64.58 |
| Total Drug Medicare Standardized Payment Amount | 64.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 895 |
| Number Of Medicare Beneficiaries With Medical Services | 638 |
| Total Medical Submitted Charge Amount | 80288.5 |
| Total Medical Medicare Allowed Amount | 55104.13 |
| Total Medical Medicare Payment Amount | 33429.38 |
| Total Medical Medicare Standardized Payment Amount | 36120.84 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 115 |
| Number Of Beneficiaries Age 65 to 74 | 262 |
| Number Of Beneficiaries Age 75 to 84 | 169 |
| Number Of Beneficiaries Age Greater 84 | 92 |
| Number Of Female Beneficiaries | 453 |
| Number Of Male Beneficiaries | 185 |
| Number Of Non Hispanic White Beneficiaries | 385 |
| Number Of Black or African American Beneficiaries | 234 |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 533 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 105 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1211 |