| National Provider Identifier [NPI]: | 1174571004 |
| Last Name Of The Provider | RISEN |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 138 CAMPBELLSVILLE BYP |
| Street Address 2 Of The Provider | |
| City Of The Provider | CAMPBELLSVILLE |
| Zip Code Of The Provider | 427188843 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 3769 |
| Number Of Medicare Beneficiaries | 1240 |
| Total Submitted Charge Amount | 337320 |
| Total Medicare Allowed Amount | 238552.2 |
| Total Medicare Payment Amount | 167763.46 |
| Total Medicare Standardized Payment Amount | 185281.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 218 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 2215 |
| Total Drug Medicare AllowedAmount | 379.42 |
| Total Drug Medicare PaymentAmount | 295.55 |
| Total Drug Medicare Standardized Payment Amount | 295.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 3551 |
| Number Of Medicare Beneficiaries With Medical Services | 1240 |
| Total Medical Submitted Charge Amount | 335105 |
| Total Medical Medicare Allowed Amount | 238172.78 |
| Total Medical Medicare Payment Amount | 167467.91 |
| Total Medical Medicare Standardized Payment Amount | 184985.69 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 205 |
| Number Of Beneficiaries Age 65 to 74 | 402 |
| Number Of Beneficiaries Age 75 to 84 | 417 |
| Number Of Beneficiaries Age Greater 84 | 216 |
| Number Of Female Beneficiaries | 715 |
| Number Of Male Beneficiaries | 525 |
| Number Of Non Hispanic White Beneficiaries | 1138 |
| Number Of Black or African American Beneficiaries | 88 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 820 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 420 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3898 |