| National Provider Identifier [NPI]: | 1629076534 |
| Last Name Of The Provider | DERSTINE |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 320 ROLLING RIDGE DR |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | STATE COLLEGE |
| Zip Code Of The Provider | 168017641 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 823 |
| Number Of Medicare Beneficiaries | 146 |
| Total Submitted Charge Amount | 195484 |
| Total Medicare Allowed Amount | 73141.72 |
| Total Medicare Payment Amount | 53364.16 |
| Total Medicare Standardized Payment Amount | 57385.09 |
| 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 | 16 |
| Number Of Medical Services | 823 |
| Number Of Medicare Beneficiaries With Medical Services | 146 |
| Total Medical Submitted Charge Amount | 195484 |
| Total Medical Medicare Allowed Amount | 73141.72 |
| Total Medical Medicare Payment Amount | 53364.16 |
| Total Medical Medicare Standardized Payment Amount | 57385.09 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 86 |
| Number Of Beneficiaries Age 65 to 74 | 37 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 93 |
| Number Of Male Beneficiaries | 53 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 77 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 24 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 39 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5978 |