| National Provider Identifier [NPI]: | 1639152085 |
| Last Name Of The Provider | MENDENHALL |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 425 3RD AVE |
| Street Address 2 Of The Provider | STE 50 |
| City Of The Provider | ALBANY |
| Zip Code Of The Provider | 317011955 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 5017 |
| Number Of Medicare Beneficiaries | 686 |
| Total Submitted Charge Amount | 1142247 |
| Total Medicare Allowed Amount | 381797.27 |
| Total Medicare Payment Amount | 290118.25 |
| Total Medicare Standardized Payment Amount | 281788.91 |
| 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 | 41 |
| Number Of Medical Services | 5017 |
| Number Of Medicare Beneficiaries With Medical Services | 686 |
| Total Medical Submitted Charge Amount | 1142247 |
| Total Medical Medicare Allowed Amount | 381797.27 |
| Total Medical Medicare Payment Amount | 290118.25 |
| Total Medical Medicare Standardized Payment Amount | 281788.91 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 93 |
| Number Of Beneficiaries Age 65 to 74 | 338 |
| Number Of Beneficiaries Age 75 to 84 | 202 |
| Number Of Beneficiaries Age Greater 84 | 53 |
| Number Of Female Beneficiaries | 308 |
| Number Of Male Beneficiaries | 378 |
| Number Of Non Hispanic White Beneficiaries | 451 |
| Number Of Black or African American Beneficiaries | |
| 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 | 521 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 165 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 70 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3656 |