| National Provider Identifier [NPI]: | 1730297730 |
| Last Name Of The Provider | QUIACHON |
| First Name Of The Provider | ERNESTO |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3490 CALKINS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FLINT |
| Zip Code Of The Provider | 485323506 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 2936 |
| Number Of Medicare Beneficiaries | 1237 |
| Total Submitted Charge Amount | 392400 |
| Total Medicare Allowed Amount | 99124.66 |
| Total Medicare Payment Amount | 74659.92 |
| Total Medicare Standardized Payment Amount | 60719.13 |
| 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 | 31 |
| Number Of Medical Services | 2936 |
| Number Of Medicare Beneficiaries With Medical Services | 1237 |
| Total Medical Submitted Charge Amount | 392400 |
| Total Medical Medicare Allowed Amount | 99124.66 |
| Total Medical Medicare Payment Amount | 74659.92 |
| Total Medical Medicare Standardized Payment Amount | 60719.13 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 270 |
| Number Of Beneficiaries Age 65 to 74 | 486 |
| Number Of Beneficiaries Age 75 to 84 | 354 |
| Number Of Beneficiaries Age Greater 84 | 127 |
| Number Of Female Beneficiaries | 713 |
| Number Of Male Beneficiaries | 524 |
| Number Of Non Hispanic White Beneficiaries | 1190 |
| Number Of Black or African American Beneficiaries | 24 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 953 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 284 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2734 |