| National Provider Identifier [NPI]: | 1093772147 |
| Last Name Of The Provider | CHARLES |
| First Name Of The Provider | ELAINE |
| Middle Initial Of The Provider | Z |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10296 BIG BEND RD |
| Street Address 2 Of The Provider | STE 206 |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631226498 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 4734 |
| Number Of Medicare Beneficiaries | 2688 |
| Total Submitted Charge Amount | 978581.62 |
| Total Medicare Allowed Amount | 248687.58 |
| Total Medicare Payment Amount | 204097.54 |
| Total Medicare Standardized Payment Amount | 208938.79 |
| 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 | 16 |
| Number Of Medical Services | 4734 |
| Number Of Medicare Beneficiaries With Medical Services | 2688 |
| Total Medical Submitted Charge Amount | 978581.62 |
| Total Medical Medicare Allowed Amount | 248687.58 |
| Total Medical Medicare Payment Amount | 204097.54 |
| Total Medical Medicare Standardized Payment Amount | 208938.79 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 120 |
| Number Of Beneficiaries Age 65 to 74 | 1364 |
| Number Of Beneficiaries Age 75 to 84 | 930 |
| Number Of Beneficiaries Age Greater 84 | 274 |
| Number Of Female Beneficiaries | 312 |
| Number Of Male Beneficiaries | 2376 |
| Number Of Non Hispanic White Beneficiaries | 2423 |
| Number Of Black or African American Beneficiaries | 194 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 44 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2598 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 90 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 34 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1031 |