| National Provider Identifier [NPI]: | 1770513657 |
| Last Name Of The Provider | PETTEY |
| First Name Of The Provider | GALEN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | PHYSICAL THERAPIST |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2600 NEWBURG RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORTUNA |
| Zip Code Of The Provider | 955402536 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Therapist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 4441 |
| Number Of Medicare Beneficiaries | 244 |
| Total Submitted Charge Amount | 204368 |
| Total Medicare Allowed Amount | 122698.77 |
| Total Medicare Payment Amount | 93013.81 |
| Total Medicare Standardized Payment Amount | 60810.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 4441 |
| Number Of Medicare Beneficiaries With Medical Services | 244 |
| Total Medical Submitted Charge Amount | 204368 |
| Total Medical Medicare Allowed Amount | 122698.77 |
| Total Medical Medicare Payment Amount | 93013.81 |
| Total Medical Medicare Standardized Payment Amount | 60810.53 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 108 |
| Number Of Beneficiaries Age 75 to 84 | 70 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 140 |
| Number Of Male Beneficiaries | 104 |
| Number Of Non Hispanic White Beneficiaries | 222 |
| 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 | 211 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9982 |