| National Provider Identifier [NPI]: | 1639168891 |
| Last Name Of The Provider | OTTO |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1005 BELLEFONTAINE AVE |
| Street Address 2 Of The Provider | SUITE 230 |
| City Of The Provider | LIMA |
| Zip Code Of The Provider | 458042851 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 1772 |
| Number Of Medicare Beneficiaries | 813 |
| Total Submitted Charge Amount | 218253 |
| Total Medicare Allowed Amount | 129419.74 |
| Total Medicare Payment Amount | 92007.04 |
| Total Medicare Standardized Payment Amount | 114292.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 46 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 610 |
| Total Drug Medicare AllowedAmount | 565.54 |
| Total Drug Medicare PaymentAmount | 549.21 |
| Total Drug Medicare Standardized Payment Amount | 549.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 1726 |
| Number Of Medicare Beneficiaries With Medical Services | 813 |
| Total Medical Submitted Charge Amount | 217643 |
| Total Medical Medicare Allowed Amount | 128854.2 |
| Total Medical Medicare Payment Amount | 91457.83 |
| Total Medical Medicare Standardized Payment Amount | 113743.36 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 309 |
| Number Of Beneficiaries Age 75 to 84 | 309 |
| Number Of Beneficiaries Age Greater 84 | 138 |
| Number Of Female Beneficiaries | 366 |
| Number Of Male Beneficiaries | 447 |
| Number Of Non Hispanic White Beneficiaries | 794 |
| 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 | 743 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 70 |
| Percent Of With Atrial Fibrillation | 34 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 72 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.4372 |