| National Provider Identifier [NPI]: | 1508892860 |
| Last Name Of The Provider | HERGESHEIMER |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 910 SYCAMORE AVE |
| Street Address 2 Of The Provider | SUITE 220 |
| City Of The Provider | VISTA |
| Zip Code Of The Provider | 920817832 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 87 |
| Number Of Services | 5731 |
| Number Of Medicare Beneficiaries | 351 |
| Total Submitted Charge Amount | 402135 |
| Total Medicare Allowed Amount | 202851.64 |
| Total Medicare Payment Amount | 164578.09 |
| Total Medicare Standardized Payment Amount | 160320.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 423 |
| Number Of Medicare Beneficiaries With Drug Services | 158 |
| Total Drug Submitted ChargeAmount | 33620 |
| Total Drug Medicare AllowedAmount | 14651.01 |
| Total Drug Medicare PaymentAmount | 12329.05 |
| Total Drug Medicare Standardized Payment Amount | 12329.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 75 |
| Number Of Medical Services | 5308 |
| Number Of Medicare Beneficiaries With Medical Services | 351 |
| Total Medical Submitted Charge Amount | 368515 |
| Total Medical Medicare Allowed Amount | 188200.63 |
| Total Medical Medicare Payment Amount | 152249.04 |
| Total Medical Medicare Standardized Payment Amount | 147991.88 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 155 |
| Number Of Beneficiaries Age 75 to 84 | 117 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 188 |
| Number Of Male Beneficiaries | 163 |
| Number Of Non Hispanic White Beneficiaries | 310 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 328 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9746 |