| National Provider Identifier [NPI]: | 1447459763 |
| Last Name Of The Provider | TETENTA |
| First Name Of The Provider | SODIENYE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MB.BS |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2301 HOUSE AVE |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | CHEYENNE |
| Zip Code Of The Provider | 820013176 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 2294 |
| Number Of Medicare Beneficiaries | 808 |
| Total Submitted Charge Amount | 1093097.89 |
| Total Medicare Allowed Amount | 288536.01 |
| Total Medicare Payment Amount | 221529.5 |
| Total Medicare Standardized Payment Amount | 226680.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 13 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 536.31 |
| Total Drug Medicare AllowedAmount | 222.58 |
| Total Drug Medicare PaymentAmount | 218.12 |
| Total Drug Medicare Standardized Payment Amount | 218.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 2281 |
| Number Of Medicare Beneficiaries With Medical Services | 808 |
| Total Medical Submitted Charge Amount | 1092561.58 |
| Total Medical Medicare Allowed Amount | 288313.43 |
| Total Medical Medicare Payment Amount | 221311.38 |
| Total Medical Medicare Standardized Payment Amount | 226462.42 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 155 |
| Number Of Beneficiaries Age 65 to 74 | 367 |
| Number Of Beneficiaries Age 75 to 84 | 230 |
| Number Of Beneficiaries Age Greater 84 | 56 |
| Number Of Female Beneficiaries | 441 |
| Number Of Male Beneficiaries | 367 |
| Number Of Non Hispanic White Beneficiaries | 728 |
| Number Of Black or African American Beneficiaries | 11 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 52 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 649 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 159 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 44 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4517 |