| National Provider Identifier [NPI]: | 1487614723 |
| Last Name Of The Provider | EUSTACE |
| First Name Of The Provider | MANOHARAN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1032 N IRISH RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DAVISON |
| Zip Code Of The Provider | 484232209 |
| 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 | 55 |
| Number Of Services | 3771 |
| Number Of Medicare Beneficiaries | 385 |
| Total Submitted Charge Amount | 325453 |
| Total Medicare Allowed Amount | 204762.92 |
| Total Medicare Payment Amount | 143626.16 |
| Total Medicare Standardized Payment Amount | 150392.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 1012 |
| Number Of Medicare Beneficiaries With Drug Services | 192 |
| Total Drug Submitted ChargeAmount | 12123 |
| Total Drug Medicare AllowedAmount | 5947.12 |
| Total Drug Medicare PaymentAmount | 5115.34 |
| Total Drug Medicare Standardized Payment Amount | 5115.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 2759 |
| Number Of Medicare Beneficiaries With Medical Services | 385 |
| Total Medical Submitted Charge Amount | 313330 |
| Total Medical Medicare Allowed Amount | 198815.8 |
| Total Medical Medicare Payment Amount | 138510.82 |
| Total Medical Medicare Standardized Payment Amount | 145277.37 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 172 |
| Number Of Beneficiaries Age 75 to 84 | 93 |
| Number Of Beneficiaries Age Greater 84 | 40 |
| Number Of Female Beneficiaries | 236 |
| Number Of Male Beneficiaries | 149 |
| Number Of Non Hispanic White Beneficiaries | 328 |
| Number Of Black or African American Beneficiaries | 45 |
| 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 | 290 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 95 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.311 |