| National Provider Identifier [NPI]: | 1255336079 |
| Last Name Of The Provider | INNOCENZI |
| First Name Of The Provider | ANTHONY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6715 TIPPECANOE RD |
| Street Address 2 Of The Provider | BUILDING F UNIT 101 |
| City Of The Provider | CANFIELD |
| Zip Code Of The Provider | 444068180 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 5401 |
| Number Of Medicare Beneficiaries | 1370 |
| Total Submitted Charge Amount | 333427 |
| Total Medicare Allowed Amount | 234371.88 |
| Total Medicare Payment Amount | 160648.31 |
| Total Medicare Standardized Payment Amount | 164577.13 |
| 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 | 18 |
| Number Of Medical Services | 5401 |
| Number Of Medicare Beneficiaries With Medical Services | 1370 |
| Total Medical Submitted Charge Amount | 333427 |
| Total Medical Medicare Allowed Amount | 234371.88 |
| Total Medical Medicare Payment Amount | 160648.31 |
| Total Medical Medicare Standardized Payment Amount | 164577.13 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 150 |
| Number Of Beneficiaries Age 65 to 74 | 216 |
| Number Of Beneficiaries Age 75 to 84 | 390 |
| Number Of Beneficiaries Age Greater 84 | 614 |
| Number Of Female Beneficiaries | 886 |
| Number Of Male Beneficiaries | 484 |
| Number Of Non Hispanic White Beneficiaries | 840 |
| Number Of Black or African American Beneficiaries | 48 |
| Number Of AsianPacific Islander Beneficiaries | 58 |
| Number Of Hispanic Beneficiaries | 222 |
| Number Of American Indian Alaska Native Beneficiaries | 187 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 203 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1167 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 71 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 22 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.946 |