| National Provider Identifier [NPI]: | 1023077518 |
| Last Name Of The Provider | CHELST |
| First Name Of The Provider | TAMY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | PHD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 22536 N BELLWOOD DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTHFIELD |
| Zip Code Of The Provider | 480342115 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Audiologist (billing independently) |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 1190 |
| Number Of Medicare Beneficiaries | 496 |
| Total Submitted Charge Amount | 118637 |
| Total Medicare Allowed Amount | 35805.55 |
| Total Medicare Payment Amount | 28073.8 |
| Total Medicare Standardized Payment Amount | 27480.08 |
| 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 | 9 |
| Number Of Medical Services | 1190 |
| Number Of Medicare Beneficiaries With Medical Services | 496 |
| Total Medical Submitted Charge Amount | 118637 |
| Total Medical Medicare Allowed Amount | 35805.55 |
| Total Medical Medicare Payment Amount | 28073.8 |
| Total Medical Medicare Standardized Payment Amount | 27480.08 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 65 |
| Number Of Beneficiaries Age 65 to 74 | 127 |
| Number Of Beneficiaries Age 75 to 84 | 131 |
| Number Of Beneficiaries Age Greater 84 | 173 |
| Number Of Female Beneficiaries | 305 |
| Number Of Male Beneficiaries | 191 |
| Number Of Non Hispanic White Beneficiaries | 186 |
| Number Of Black or African American Beneficiaries | 298 |
| 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 | 30 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 466 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 58 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 56 |
| Percent Of With Diabetes | 58 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 67 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 33 |
| Percent Of With Stroke | 29 |
| Average HCC Risk Score Of Beneficiaries | 2.9847 |