| National Provider Identifier [NPI]: | 1598041949 |
| Last Name Of The Provider | GENDERNALIK |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 29260 FRANKLIN RD |
| Street Address 2 Of The Provider | SUITE 121 |
| City Of The Provider | SOUTHFIELD |
| Zip Code Of The Provider | 480341161 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 542 |
| Number Of Medicare Beneficiaries | 75 |
| Total Submitted Charge Amount | 28255.07 |
| Total Medicare Allowed Amount | 10767.86 |
| Total Medicare Payment Amount | 7666.78 |
| Total Medicare Standardized Payment Amount | 7528.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 291 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 7112 |
| Total Drug Medicare AllowedAmount | 2642.03 |
| Total Drug Medicare PaymentAmount | 1888.57 |
| Total Drug Medicare Standardized Payment Amount | 1888.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 251 |
| Number Of Medicare Beneficiaries With Medical Services | 74 |
| Total Medical Submitted Charge Amount | 21143.07 |
| Total Medical Medicare Allowed Amount | 8125.83 |
| Total Medical Medicare Payment Amount | 5778.21 |
| Total Medical Medicare Standardized Payment Amount | 5639.55 |
| Average Age Of Beneficiaries | 49 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 33 |
| Number Of Male Beneficiaries | 42 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 57 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 0 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 21 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 65 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 28 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 65 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0611 |