| National Provider Identifier [NPI]: | 1871561654 |
| Last Name Of The Provider | WITTENBERG |
| First Name Of The Provider | MARC |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7650 DIXIE HWY |
| Street Address 2 Of The Provider | SUITE 140 |
| City Of The Provider | CLARKSTON |
| Zip Code Of The Provider | 483462078 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 42513 |
| Number Of Medicare Beneficiaries | 682 |
| Total Submitted Charge Amount | 1231534 |
| Total Medicare Allowed Amount | 386035.6 |
| Total Medicare Payment Amount | 283700.27 |
| Total Medicare Standardized Payment Amount | 269438.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 39229 |
| Number Of Medicare Beneficiaries With Drug Services | 482 |
| Total Drug Submitted ChargeAmount | 20972 |
| Total Drug Medicare AllowedAmount | 20139.36 |
| Total Drug Medicare PaymentAmount | 14324.98 |
| Total Drug Medicare Standardized Payment Amount | 14324.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 3284 |
| Number Of Medicare Beneficiaries With Medical Services | 682 |
| Total Medical Submitted Charge Amount | 1210562 |
| Total Medical Medicare Allowed Amount | 365896.24 |
| Total Medical Medicare Payment Amount | 269375.29 |
| Total Medical Medicare Standardized Payment Amount | 255113.99 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 125 |
| Number Of Beneficiaries Age 65 to 74 | 272 |
| Number Of Beneficiaries Age 75 to 84 | 205 |
| Number Of Beneficiaries Age Greater 84 | 80 |
| Number Of Female Beneficiaries | 407 |
| Number Of Male Beneficiaries | 275 |
| Number Of Non Hispanic White Beneficiaries | 596 |
| Number Of Black or African American Beneficiaries | 63 |
| 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 | 625 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 67 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2395 |