| National Provider Identifier [NPI]: | 1558557785 |
| Last Name Of The Provider | PETTY |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3350 LA JOLLA VILLAGE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN DIEGO |
| Zip Code Of The Provider | 921610002 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 747 |
| Number Of Medicare Beneficiaries | 221 |
| Total Submitted Charge Amount | 107040 |
| Total Medicare Allowed Amount | 35824.59 |
| Total Medicare Payment Amount | 25547.47 |
| Total Medicare Standardized Payment Amount | 32263.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 104 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 935 |
| Total Drug Medicare AllowedAmount | 534.11 |
| Total Drug Medicare PaymentAmount | 400.81 |
| Total Drug Medicare Standardized Payment Amount | 400.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 643 |
| Number Of Medicare Beneficiaries With Medical Services | 221 |
| Total Medical Submitted Charge Amount | 106105 |
| Total Medical Medicare Allowed Amount | 35290.48 |
| Total Medical Medicare Payment Amount | 25146.66 |
| Total Medical Medicare Standardized Payment Amount | 31862.89 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 96 |
| Number Of Beneficiaries Age 75 to 84 | 52 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 141 |
| Number Of Male Beneficiaries | 80 |
| Number Of Non Hispanic White Beneficiaries | 178 |
| 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 | 183 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 38 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1718 |