| National Provider Identifier [NPI]: | 1861485518 |
| Last Name Of The Provider | AMGOTT |
| First Name Of The Provider | THEODORE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1223 GATEWAY DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MELBOURNE |
| Zip Code Of The Provider | 329012607 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 94 |
| Number Of Services | 3815 |
| Number Of Medicare Beneficiaries | 812 |
| Total Submitted Charge Amount | 693332.5 |
| Total Medicare Allowed Amount | 340173.26 |
| Total Medicare Payment Amount | 259444.94 |
| Total Medicare Standardized Payment Amount | 263092.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 102 |
| Number Of Medicare Beneficiaries With Drug Services | 85 |
| Total Drug Submitted ChargeAmount | 11626 |
| Total Drug Medicare AllowedAmount | 6444.09 |
| Total Drug Medicare PaymentAmount | 6306.25 |
| Total Drug Medicare Standardized Payment Amount | 6306.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 89 |
| Number Of Medical Services | 3713 |
| Number Of Medicare Beneficiaries With Medical Services | 812 |
| Total Medical Submitted Charge Amount | 681706.5 |
| Total Medical Medicare Allowed Amount | 333729.17 |
| Total Medical Medicare Payment Amount | 253138.69 |
| Total Medical Medicare Standardized Payment Amount | 256786.5 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 78 |
| Number Of Beneficiaries Age 65 to 74 | 332 |
| Number Of Beneficiaries Age 75 to 84 | 283 |
| Number Of Beneficiaries Age Greater 84 | 119 |
| Number Of Female Beneficiaries | 393 |
| Number Of Male Beneficiaries | 419 |
| Number Of Non Hispanic White Beneficiaries | 740 |
| Number Of Black or African American Beneficiaries | 26 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 727 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 85 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 48 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.8708 |