| National Provider Identifier [NPI]: | 1033296330 |
| Last Name Of The Provider | WATHNE |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 333 N 18TH AVE STE D1 |
| Street Address 2 Of The Provider | |
| City Of The Provider | POCATELLO |
| Zip Code Of The Provider | 832013358 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 561 |
| Number Of Medicare Beneficiaries | 142 |
| Total Submitted Charge Amount | 435936.82 |
| Total Medicare Allowed Amount | 97910.93 |
| Total Medicare Payment Amount | 74142.44 |
| Total Medicare Standardized Payment Amount | 82819.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 121 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 1210 |
| Total Drug Medicare AllowedAmount | 690.93 |
| Total Drug Medicare PaymentAmount | 464.01 |
| Total Drug Medicare Standardized Payment Amount | 464.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 440 |
| Number Of Medicare Beneficiaries With Medical Services | 142 |
| Total Medical Submitted Charge Amount | 434726.82 |
| Total Medical Medicare Allowed Amount | 97220 |
| Total Medical Medicare Payment Amount | 73678.43 |
| Total Medical Medicare Standardized Payment Amount | 82355.43 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 75 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 72 |
| Number Of Male Beneficiaries | 70 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 123 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9857 |