| National Provider Identifier [NPI]: | 1568519635 |
| Last Name Of The Provider | LO |
| First Name Of The Provider | GUSTAV |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 116 W MITCHELL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PETOSKEY |
| Zip Code Of The Provider | 497702324 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 170 |
| Number Of Services | 7331 |
| Number Of Medicare Beneficiaries | 1123 |
| Total Submitted Charge Amount | 454453.75 |
| Total Medicare Allowed Amount | 314941.76 |
| Total Medicare Payment Amount | 222743.23 |
| Total Medicare Standardized Payment Amount | 238670.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 1405.5 |
| Number Of Medicare Beneficiaries With Drug Services | 268 |
| Total Drug Submitted ChargeAmount | 18568.75 |
| Total Drug Medicare AllowedAmount | 9912.22 |
| Total Drug Medicare PaymentAmount | 7190.22 |
| Total Drug Medicare Standardized Payment Amount | 7190.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 158 |
| Number Of Medical Services | 5925.5 |
| Number Of Medicare Beneficiaries With Medical Services | 1123 |
| Total Medical Submitted Charge Amount | 435885 |
| Total Medical Medicare Allowed Amount | 305029.54 |
| Total Medical Medicare Payment Amount | 215553.01 |
| Total Medical Medicare Standardized Payment Amount | 231480.34 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 211 |
| Number Of Beneficiaries Age 65 to 74 | 549 |
| Number Of Beneficiaries Age 75 to 84 | 270 |
| Number Of Beneficiaries Age Greater 84 | 93 |
| Number Of Female Beneficiaries | 608 |
| Number Of Male Beneficiaries | 515 |
| Number Of Non Hispanic White Beneficiaries | 1059 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 31 |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 954 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 169 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.8603 |