| National Provider Identifier [NPI]: | 1134196751 |
| Last Name Of The Provider | RUNTE |
| First Name Of The Provider | KENNAN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 123 MARGARET LANE |
| Street Address 2 Of The Provider | STE B-1 |
| City Of The Provider | GRASS VALLEY |
| Zip Code Of The Provider | 95945 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 82 |
| Number Of Services | 4320 |
| Number Of Medicare Beneficiaries | 1083 |
| Total Submitted Charge Amount | 529510.67 |
| Total Medicare Allowed Amount | 284596.06 |
| Total Medicare Payment Amount | 202975.13 |
| Total Medicare Standardized Payment Amount | 194907.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 95 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 1425 |
| Total Drug Medicare AllowedAmount | 80.33 |
| Total Drug Medicare PaymentAmount | 60.78 |
| Total Drug Medicare Standardized Payment Amount | 60.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 4225 |
| Number Of Medicare Beneficiaries With Medical Services | 1083 |
| Total Medical Submitted Charge Amount | 528085.67 |
| Total Medical Medicare Allowed Amount | 284515.73 |
| Total Medical Medicare Payment Amount | 202914.35 |
| Total Medical Medicare Standardized Payment Amount | 194846.82 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 79 |
| Number Of Beneficiaries Age 65 to 74 | 383 |
| Number Of Beneficiaries Age 75 to 84 | 310 |
| Number Of Beneficiaries Age Greater 84 | 311 |
| Number Of Female Beneficiaries | 632 |
| Number Of Male Beneficiaries | 451 |
| Number Of Non Hispanic White Beneficiaries | 1042 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 863 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 220 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3956 |