| National Provider Identifier [NPI]: | 1245210244 |
| Last Name Of The Provider | PETRYK |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1930 TAMARACK RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEWARK |
| Zip Code Of The Provider | 430552303 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 135 |
| Number Of Services | 10916 |
| Number Of Medicare Beneficiaries | 1131 |
| Total Submitted Charge Amount | 627277 |
| Total Medicare Allowed Amount | 425780.88 |
| Total Medicare Payment Amount | 320929.33 |
| Total Medicare Standardized Payment Amount | 330731.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 2147 |
| Number Of Medicare Beneficiaries With Drug Services | 198 |
| Total Drug Submitted ChargeAmount | 64403 |
| Total Drug Medicare AllowedAmount | 28504.38 |
| Total Drug Medicare PaymentAmount | 22579.01 |
| Total Drug Medicare Standardized Payment Amount | 22579.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 121 |
| Number Of Medical Services | 8769 |
| Number Of Medicare Beneficiaries With Medical Services | 1131 |
| Total Medical Submitted Charge Amount | 562874 |
| Total Medical Medicare Allowed Amount | 397276.5 |
| Total Medical Medicare Payment Amount | 298350.32 |
| Total Medical Medicare Standardized Payment Amount | 308152.26 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 182 |
| Number Of Beneficiaries Age 65 to 74 | 364 |
| Number Of Beneficiaries Age 75 to 84 | 342 |
| Number Of Beneficiaries Age Greater 84 | 243 |
| Number Of Female Beneficiaries | 677 |
| Number Of Male Beneficiaries | 454 |
| Number Of Non Hispanic White Beneficiaries | 1094 |
| Number Of Black or African American Beneficiaries | 21 |
| 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 | 814 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 317 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3994 |