| National Provider Identifier [NPI]: | 1578680278 |
| Last Name Of The Provider | LAVANWAY |
| First Name Of The Provider | NICHOLE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1500 E MEDICAL CENTER DR |
| Street Address 2 Of The Provider | B1-380 TC |
| City Of The Provider | ANN ARBOR |
| Zip Code Of The Provider | 481090999 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 571 |
| Number Of Medicare Beneficiaries | 472 |
| Total Submitted Charge Amount | 305317 |
| Total Medicare Allowed Amount | 93215.39 |
| Total Medicare Payment Amount | 70579.57 |
| Total Medicare Standardized Payment Amount | 66013.46 |
| 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 | 31 |
| Number Of Medical Services | 571 |
| Number Of Medicare Beneficiaries With Medical Services | 472 |
| Total Medical Submitted Charge Amount | 305317 |
| Total Medical Medicare Allowed Amount | 93215.39 |
| Total Medical Medicare Payment Amount | 70579.57 |
| Total Medical Medicare Standardized Payment Amount | 66013.46 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 83 |
| Number Of Beneficiaries Age 65 to 74 | 143 |
| Number Of Beneficiaries Age 75 to 84 | 149 |
| Number Of Beneficiaries Age Greater 84 | 97 |
| Number Of Female Beneficiaries | 272 |
| Number Of Male Beneficiaries | 200 |
| Number Of Non Hispanic White Beneficiaries | 398 |
| Number Of Black or African American Beneficiaries | 21 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 365 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 107 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.0938 |