| National Provider Identifier [NPI]: | 1861687923 |
| Last Name Of The Provider | ROTH |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | DO, MBA, MS |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2512 E DUPONT RD |
| Street Address 2 Of The Provider | SUITE #200 |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468251609 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Medicine and Rehabilitation |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 15741 |
| Number Of Medicare Beneficiaries | 684 |
| Total Submitted Charge Amount | 4373405.3 |
| Total Medicare Allowed Amount | 851876.47 |
| Total Medicare Payment Amount | 679559.44 |
| Total Medicare Standardized Payment Amount | 693670.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 4113 |
| Number Of Medicare Beneficiaries With Drug Services | 403 |
| Total Drug Submitted ChargeAmount | 112500 |
| Total Drug Medicare AllowedAmount | 29063.52 |
| Total Drug Medicare PaymentAmount | 22273.86 |
| Total Drug Medicare Standardized Payment Amount | 22273.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 11628 |
| Number Of Medicare Beneficiaries With Medical Services | 683 |
| Total Medical Submitted Charge Amount | 4260905.3 |
| Total Medical Medicare Allowed Amount | 822812.95 |
| Total Medical Medicare Payment Amount | 657285.58 |
| Total Medical Medicare Standardized Payment Amount | 671396.2 |
| Average Age Of Beneficiaries | 56 |
| Number Of Beneficiaries Age Less65 | 505 |
| Number Of Beneficiaries Age 65 to 74 | 106 |
| Number Of Beneficiaries Age 75 to 84 | 49 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 432 |
| Number Of Male Beneficiaries | 252 |
| Number Of Non Hispanic White Beneficiaries | 601 |
| Number Of Black or African American Beneficiaries | 53 |
| 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 | 279 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 405 |
| Percent Of With Atrial Fibrillation | 2 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 50 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.336 |