| National Provider Identifier [NPI]: | 1639158538 |
| Last Name Of The Provider | GOTTLICH |
| First Name Of The Provider | MALCOLM |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1075 MASON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | DAYTONA BEACH |
| Zip Code Of The Provider | 32117 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 180 |
| Number Of Services | 11880 |
| Number Of Medicare Beneficiaries | 1578 |
| Total Submitted Charge Amount | 2251699.36 |
| Total Medicare Allowed Amount | 779808.05 |
| Total Medicare Payment Amount | 589273.55 |
| Total Medicare Standardized Payment Amount | 572488.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 2160 |
| Number Of Medicare Beneficiaries With Drug Services | 379 |
| Total Drug Submitted ChargeAmount | 104477 |
| Total Drug Medicare AllowedAmount | 47276.11 |
| Total Drug Medicare PaymentAmount | 36225.17 |
| Total Drug Medicare Standardized Payment Amount | 36225.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 173 |
| Number Of Medical Services | 9720 |
| Number Of Medicare Beneficiaries With Medical Services | 1578 |
| Total Medical Submitted Charge Amount | 2147222.36 |
| Total Medical Medicare Allowed Amount | 732531.94 |
| Total Medical Medicare Payment Amount | 553048.38 |
| Total Medical Medicare Standardized Payment Amount | 536263.56 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 152 |
| Number Of Beneficiaries Age 65 to 74 | 694 |
| Number Of Beneficiaries Age 75 to 84 | 496 |
| Number Of Beneficiaries Age Greater 84 | 236 |
| Number Of Female Beneficiaries | 977 |
| Number Of Male Beneficiaries | 601 |
| Number Of Non Hispanic White Beneficiaries | 1435 |
| Number Of Black or African American Beneficiaries | 92 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1354 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 224 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 21 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2603 |