| National Provider Identifier [NPI]: | 1609828094 |
| Last Name Of The Provider | PETHKE |
| First Name Of The Provider | SCOTT |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1301 BROAD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUGUSTA |
| Zip Code Of The Provider | 309011055 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 3323 |
| Number Of Medicare Beneficiaries | 679 |
| Total Submitted Charge Amount | 505186 |
| Total Medicare Allowed Amount | 286932.42 |
| Total Medicare Payment Amount | 220825.36 |
| Total Medicare Standardized Payment Amount | 232217.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 28 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 2215 |
| Total Drug Medicare AllowedAmount | 1712.51 |
| Total Drug Medicare PaymentAmount | 1678.22 |
| Total Drug Medicare Standardized Payment Amount | 1678.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 3295 |
| Number Of Medicare Beneficiaries With Medical Services | 679 |
| Total Medical Submitted Charge Amount | 502971 |
| Total Medical Medicare Allowed Amount | 285219.91 |
| Total Medical Medicare Payment Amount | 219147.14 |
| Total Medical Medicare Standardized Payment Amount | 230538.9 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 134 |
| Number Of Beneficiaries Age 65 to 74 | 258 |
| Number Of Beneficiaries Age 75 to 84 | 214 |
| Number Of Beneficiaries Age Greater 84 | 73 |
| Number Of Female Beneficiaries | 385 |
| Number Of Male Beneficiaries | 294 |
| Number Of Non Hispanic White Beneficiaries | 501 |
| Number Of Black or African American Beneficiaries | 160 |
| 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 | 516 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 163 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 48 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 57 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.2491 |