| National Provider Identifier [NPI]: | 1154596765 |
| Last Name Of The Provider | PUCKETT |
| First Name Of The Provider | FREDRIC |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2203 W LAMPASAS ST |
| Street Address 2 Of The Provider | SUITE 205 |
| City Of The Provider | ENNIS |
| Zip Code Of The Provider | 751195644 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 1545 |
| Number Of Medicare Beneficiaries | 307 |
| Total Submitted Charge Amount | 300334.84 |
| Total Medicare Allowed Amount | 77881.39 |
| Total Medicare Payment Amount | 54691.56 |
| Total Medicare Standardized Payment Amount | 60754.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 177 |
| Number Of Medicare Beneficiaries With Drug Services | 71 |
| Total Drug Submitted ChargeAmount | 2810 |
| Total Drug Medicare AllowedAmount | 1019.34 |
| Total Drug Medicare PaymentAmount | 962.13 |
| Total Drug Medicare Standardized Payment Amount | 962.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 1368 |
| Number Of Medicare Beneficiaries With Medical Services | 306 |
| Total Medical Submitted Charge Amount | 297524.84 |
| Total Medical Medicare Allowed Amount | 76862.05 |
| Total Medical Medicare Payment Amount | 53729.43 |
| Total Medical Medicare Standardized Payment Amount | 59792.25 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 76 |
| Number Of Beneficiaries Age 65 to 74 | 117 |
| Number Of Beneficiaries Age 75 to 84 | 76 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 191 |
| Number Of Male Beneficiaries | 116 |
| Number Of Non Hispanic White Beneficiaries | 239 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 212 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 95 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4217 |