| National Provider Identifier [NPI]: | 1063613180 |
| Last Name Of The Provider | EHLENBERGER |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 110 LONGWOOD AVE |
| Street Address 2 Of The Provider | DEPT. OF RADIOLOGY |
| City Of The Provider | ROCKLEDGE |
| Zip Code Of The Provider | 329552828 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 248 |
| Number Of Services | 6046 |
| Number Of Medicare Beneficiaries | 3278 |
| Total Submitted Charge Amount | 642630 |
| Total Medicare Allowed Amount | 200313.08 |
| Total Medicare Payment Amount | 153770.41 |
| Total Medicare Standardized Payment Amount | 154459.22 |
| 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 | 248 |
| Number Of Medical Services | 6046 |
| Number Of Medicare Beneficiaries With Medical Services | 3278 |
| Total Medical Submitted Charge Amount | 642630 |
| Total Medical Medicare Allowed Amount | 200313.08 |
| Total Medical Medicare Payment Amount | 153770.41 |
| Total Medical Medicare Standardized Payment Amount | 154459.22 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 531 |
| Number Of Beneficiaries Age 65 to 74 | 1125 |
| Number Of Beneficiaries Age 75 to 84 | 1086 |
| Number Of Beneficiaries Age Greater 84 | 536 |
| Number Of Female Beneficiaries | 1956 |
| Number Of Male Beneficiaries | 1322 |
| Number Of Non Hispanic White Beneficiaries | 2792 |
| Number Of Black or African American Beneficiaries | 313 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 111 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2524 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 754 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.745 |