| National Provider Identifier [NPI]: | 1699769190 |
| Last Name Of The Provider | GODOSHIAN |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 27177 LAHSER RD |
| Street Address 2 Of The Provider | SUITE 104 |
| City Of The Provider | SOUTHFIELD |
| Zip Code Of The Provider | 480344714 |
| 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 | 40 |
| Number Of Services | 4486 |
| Number Of Medicare Beneficiaries | 689 |
| Total Submitted Charge Amount | 338335.5 |
| Total Medicare Allowed Amount | 250956.17 |
| Total Medicare Payment Amount | 192390.95 |
| Total Medicare Standardized Payment Amount | 189385.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 156 |
| Number Of Medicare Beneficiaries With Drug Services | 132 |
| Total Drug Submitted ChargeAmount | 5328.5 |
| Total Drug Medicare AllowedAmount | 4081.2 |
| Total Drug Medicare PaymentAmount | 3834.36 |
| Total Drug Medicare Standardized Payment Amount | 3834.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 4330 |
| Number Of Medicare Beneficiaries With Medical Services | 689 |
| Total Medical Submitted Charge Amount | 333007 |
| Total Medical Medicare Allowed Amount | 246874.97 |
| Total Medical Medicare Payment Amount | 188556.59 |
| Total Medical Medicare Standardized Payment Amount | 185551.4 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 304 |
| Number Of Beneficiaries Age 75 to 84 | 256 |
| Number Of Beneficiaries Age Greater 84 | 97 |
| Number Of Female Beneficiaries | 382 |
| Number Of Male Beneficiaries | 307 |
| Number Of Non Hispanic White Beneficiaries | 495 |
| Number Of Black or African American Beneficiaries | 165 |
| 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 | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 635 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.079 |