| National Provider Identifier [NPI]: | 1306954946 |
| Last Name Of The Provider | LIBBY |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 21008 NORTHERN BLVD |
| Street Address 2 Of The Provider | SUITE 3 |
| City Of The Provider | BAYSIDE |
| Zip Code Of The Provider | 113613211 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 3936 |
| Number Of Medicare Beneficiaries | 678 |
| Total Submitted Charge Amount | 1216038.71 |
| Total Medicare Allowed Amount | 312848.14 |
| Total Medicare Payment Amount | 236045.32 |
| Total Medicare Standardized Payment Amount | 206122.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 367 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 61224.84 |
| Total Drug Medicare AllowedAmount | 21510.5 |
| Total Drug Medicare PaymentAmount | 16727.16 |
| Total Drug Medicare Standardized Payment Amount | 16727.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 3569 |
| Number Of Medicare Beneficiaries With Medical Services | 678 |
| Total Medical Submitted Charge Amount | 1154813.87 |
| Total Medical Medicare Allowed Amount | 291337.64 |
| Total Medical Medicare Payment Amount | 219318.16 |
| Total Medical Medicare Standardized Payment Amount | 189395.37 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 254 |
| Number Of Beneficiaries Age 75 to 84 | 241 |
| Number Of Beneficiaries Age Greater 84 | 148 |
| Number Of Female Beneficiaries | 124 |
| Number Of Male Beneficiaries | 554 |
| Number Of Non Hispanic White Beneficiaries | 565 |
| Number Of Black or African American Beneficiaries | 37 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 621 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2643 |