| National Provider Identifier [NPI]: | 1134121825 |
| Last Name Of The Provider | PETEIN |
| First Name Of The Provider | MARC |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 13634 N 93RD AVE |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 853814915 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 7772 |
| Number Of Medicare Beneficiaries | 1154 |
| Total Submitted Charge Amount | 1433616 |
| Total Medicare Allowed Amount | 753598.34 |
| Total Medicare Payment Amount | 564838.05 |
| Total Medicare Standardized Payment Amount | 568906.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 815 |
| Number Of Medicare Beneficiaries With Drug Services | 195 |
| Total Drug Submitted ChargeAmount | 81523 |
| Total Drug Medicare AllowedAmount | 40137.92 |
| Total Drug Medicare PaymentAmount | 31467.03 |
| Total Drug Medicare Standardized Payment Amount | 31467.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 6957 |
| Number Of Medicare Beneficiaries With Medical Services | 1154 |
| Total Medical Submitted Charge Amount | 1352093 |
| Total Medical Medicare Allowed Amount | 713460.42 |
| Total Medical Medicare Payment Amount | 533371.02 |
| Total Medical Medicare Standardized Payment Amount | 537438.99 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 386 |
| Number Of Beneficiaries Age 75 to 84 | 437 |
| Number Of Beneficiaries Age Greater 84 | 311 |
| Number Of Female Beneficiaries | 595 |
| Number Of Male Beneficiaries | 559 |
| Number Of Non Hispanic White Beneficiaries | 1092 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1117 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.4619 |