| National Provider Identifier [NPI]: | 1548214547 |
| Last Name Of The Provider | BUTTRICK |
| 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 | 4045 WADSWORTH BLVD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | WHEAT RIDGE |
| Zip Code Of The Provider | 800334642 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 998 |
| Number Of Medicare Beneficiaries | 124 |
| Total Submitted Charge Amount | 111174 |
| Total Medicare Allowed Amount | 69909.71 |
| Total Medicare Payment Amount | 50760.7 |
| Total Medicare Standardized Payment Amount | 51305.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 400 |
| Total Drug Medicare AllowedAmount | 307.56 |
| Total Drug Medicare PaymentAmount | 301.37 |
| Total Drug Medicare Standardized Payment Amount | 301.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 978 |
| Number Of Medicare Beneficiaries With Medical Services | 124 |
| Total Medical Submitted Charge Amount | 110774 |
| Total Medical Medicare Allowed Amount | 69602.15 |
| Total Medical Medicare Payment Amount | 50459.33 |
| Total Medical Medicare Standardized Payment Amount | 51003.76 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 56 |
| Number Of Beneficiaries Age 75 to 84 | 30 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 62 |
| Number Of Male Beneficiaries | 62 |
| Number Of Non Hispanic White Beneficiaries | 109 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 106 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0774 |