| National Provider Identifier [NPI]: | 1366609851 |
| Last Name Of The Provider | TRIVAX |
| First Name Of The Provider | CORY |
| Middle Initial Of The Provider | Z |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2799 W GRAND BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DETROIT |
| Zip Code Of The Provider | 482022608 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 160 |
| Number Of Services | 5921 |
| Number Of Medicare Beneficiaries | 3751 |
| Total Submitted Charge Amount | 358673 |
| Total Medicare Allowed Amount | 151234.78 |
| Total Medicare Payment Amount | 121873.11 |
| Total Medicare Standardized Payment Amount | 118717.39 |
| 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 | 160 |
| Number Of Medical Services | 5921 |
| Number Of Medicare Beneficiaries With Medical Services | 3751 |
| Total Medical Submitted Charge Amount | 358673 |
| Total Medical Medicare Allowed Amount | 151234.78 |
| Total Medical Medicare Payment Amount | 121873.11 |
| Total Medical Medicare Standardized Payment Amount | 118717.39 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 676 |
| Number Of Beneficiaries Age 65 to 74 | 1635 |
| Number Of Beneficiaries Age 75 to 84 | 1046 |
| Number Of Beneficiaries Age Greater 84 | 394 |
| Number Of Female Beneficiaries | 2743 |
| Number Of Male Beneficiaries | 1008 |
| Number Of Non Hispanic White Beneficiaries | 2924 |
| Number Of Black or African American Beneficiaries | 682 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 46 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 53 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3022 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 729 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5623 |