| National Provider Identifier [NPI]: | 1134393796 |
| Last Name Of The Provider | KETTERER |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3060 WOODFIELD WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | CUMMING |
| Zip Code Of The Provider | 300407191 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 1014 |
| Number Of Medicare Beneficiaries | 122 |
| Total Submitted Charge Amount | 130753 |
| Total Medicare Allowed Amount | 59270.58 |
| Total Medicare Payment Amount | 46476.93 |
| Total Medicare Standardized Payment Amount | 46502.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 375 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 16570 |
| Total Drug Medicare AllowedAmount | 1824.07 |
| Total Drug Medicare PaymentAmount | 1511.24 |
| Total Drug Medicare Standardized Payment Amount | 1511.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 639 |
| Number Of Medicare Beneficiaries With Medical Services | 122 |
| Total Medical Submitted Charge Amount | 114183 |
| Total Medical Medicare Allowed Amount | 57446.51 |
| Total Medical Medicare Payment Amount | 44965.69 |
| Total Medical Medicare Standardized Payment Amount | 44990.93 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 36 |
| Number Of Beneficiaries Age 75 to 84 | 32 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 57 |
| Number Of Male Beneficiaries | 65 |
| Number Of Non Hispanic White Beneficiaries | 69 |
| 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 | 90 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 3.2821 |