| National Provider Identifier [NPI]: | 1326087057 |
| Last Name Of The Provider | OSBORNE |
| First Name Of The Provider | THERESA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4069 LAKE DR SE |
| Street Address 2 Of The Provider | SUITE 117 |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 495468816 |
| 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 | 136 |
| Number Of Services | 10195 |
| Number Of Medicare Beneficiaries | 5498 |
| Total Submitted Charge Amount | 1287846 |
| Total Medicare Allowed Amount | 429342.24 |
| Total Medicare Payment Amount | 333119.86 |
| Total Medicare Standardized Payment Amount | 364330.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 2878 |
| Total Drug Medicare AllowedAmount | 906.24 |
| Total Drug Medicare PaymentAmount | 826.01 |
| Total Drug Medicare Standardized Payment Amount | 826.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 128 |
| Number Of Medical Services | 10171 |
| Number Of Medicare Beneficiaries With Medical Services | 5497 |
| Total Medical Submitted Charge Amount | 1284968 |
| Total Medical Medicare Allowed Amount | 428436 |
| Total Medical Medicare Payment Amount | 332293.85 |
| Total Medical Medicare Standardized Payment Amount | 363504.92 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 934 |
| Number Of Beneficiaries Age 65 to 74 | 2201 |
| Number Of Beneficiaries Age 75 to 84 | 1584 |
| Number Of Beneficiaries Age Greater 84 | 779 |
| Number Of Female Beneficiaries | 3790 |
| Number Of Male Beneficiaries | 1708 |
| Number Of Non Hispanic White Beneficiaries | 5012 |
| Number Of Black or African American Beneficiaries | 203 |
| Number Of AsianPacific Islander Beneficiaries | 37 |
| Number Of Hispanic Beneficiaries | 149 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | 86 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4573 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 925 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1839 |