National Provider Identifier [NPI]: |
1821398769 |
Last Name Of The Provider |
PETRE |
First Name Of The Provider |
MARK |
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 |
4260 GLENDALE MILFORD RD |
Street Address 2 Of The Provider |
SUITE 103 |
City Of The Provider |
BLUE ASH |
Zip Code Of The Provider |
452423763 |
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 |
83 |
Number Of Services |
2353 |
Number Of Medicare Beneficiaries |
553 |
Total Submitted Charge Amount |
277975 |
Total Medicare Allowed Amount |
181164.27 |
Total Medicare Payment Amount |
134727.66 |
Total Medicare Standardized Payment Amount |
140971.38 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
13 |
Number Of Medicare Beneficiaries With Drug Services |
11 |
Total Drug Submitted ChargeAmount |
39 |
Total Drug Medicare AllowedAmount |
18.21 |
Total Drug Medicare PaymentAmount |
12.87 |
Total Drug Medicare Standardized Payment Amount |
12.87 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
81 |
Number Of Medical Services |
2340 |
Number Of Medicare Beneficiaries With Medical Services |
553 |
Total Medical Submitted Charge Amount |
277936 |
Total Medical Medicare Allowed Amount |
181146.06 |
Total Medical Medicare Payment Amount |
134714.79 |
Total Medical Medicare Standardized Payment Amount |
140958.51 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
98 |
Number Of Beneficiaries Age 65 to 74 |
141 |
Number Of Beneficiaries Age 75 to 84 |
157 |
Number Of Beneficiaries Age Greater 84 |
157 |
Number Of Female Beneficiaries |
336 |
Number Of Male Beneficiaries |
217 |
Number Of Non Hispanic White Beneficiaries |
418 |
Number Of Black or African American Beneficiaries |
123 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
0 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
348 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
205 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
31 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
34 |
Percent Of With Chronic Kidney Disease |
39 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
30 |
Percent Of With Diabetes |
52 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
42 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
10 |
Average HCC Risk Score Of Beneficiaries |
2.0611 |