| National Provider Identifier [NPI]: | 1619023249 |
| Last Name Of The Provider | UNTERHALTER |
| First Name Of The Provider | STEFAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9001 WILSHIRE BLVD |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | BEVERLY HILLS |
| Zip Code Of The Provider | 902111838 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 1740 |
| Number Of Medicare Beneficiaries | 288 |
| Total Submitted Charge Amount | 363445 |
| Total Medicare Allowed Amount | 192916.21 |
| Total Medicare Payment Amount | 145470.4 |
| Total Medicare Standardized Payment Amount | 135527 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 57 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 2060 |
| Total Drug Medicare AllowedAmount | 584.58 |
| Total Drug Medicare PaymentAmount | 568.12 |
| Total Drug Medicare Standardized Payment Amount | 568.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 1683 |
| Number Of Medicare Beneficiaries With Medical Services | 288 |
| Total Medical Submitted Charge Amount | 361385 |
| Total Medical Medicare Allowed Amount | 192331.63 |
| Total Medical Medicare Payment Amount | 144902.28 |
| Total Medical Medicare Standardized Payment Amount | 134958.88 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 114 |
| Number Of Beneficiaries Age 75 to 84 | 89 |
| Number Of Beneficiaries Age Greater 84 | 52 |
| Number Of Female Beneficiaries | 152 |
| Number Of Male Beneficiaries | 136 |
| Number Of Non Hispanic White Beneficiaries | 191 |
| Number Of Black or African American Beneficiaries | 59 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 203 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 85 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.4631 |