| National Provider Identifier [NPI]: | 1033187299 |
| Last Name Of The Provider | MBONU |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2604 ST. MICHAEL DRIVE |
| Street Address 2 Of The Provider | SUITE 310 |
| City Of The Provider | TEXARKANA |
| Zip Code Of The Provider | 75503 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 261949 |
| Number Of Medicare Beneficiaries | 240 |
| Total Submitted Charge Amount | 1236172.21 |
| Total Medicare Allowed Amount | 463773.94 |
| Total Medicare Payment Amount | 361028.47 |
| Total Medicare Standardized Payment Amount | 374416.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 257787 |
| Number Of Medicare Beneficiaries With Drug Services | 53 |
| Total Drug Submitted ChargeAmount | 411094.31 |
| Total Drug Medicare AllowedAmount | 196246.25 |
| Total Drug Medicare PaymentAmount | 153667.64 |
| Total Drug Medicare Standardized Payment Amount | 153667.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 4162 |
| Number Of Medicare Beneficiaries With Medical Services | 240 |
| Total Medical Submitted Charge Amount | 825077.9 |
| Total Medical Medicare Allowed Amount | 267527.69 |
| Total Medical Medicare Payment Amount | 207360.83 |
| Total Medical Medicare Standardized Payment Amount | 220748.89 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 91 |
| Number Of Beneficiaries Age 75 to 84 | 64 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 117 |
| Number Of Male Beneficiaries | 123 |
| Number Of Non Hispanic White Beneficiaries | 184 |
| Number Of Black or African American Beneficiaries | 45 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 178 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 53 |
| Percent Of With Chronic Kidney Disease | 61 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 42 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 55 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.5834 |