| National Provider Identifier [NPI]: | 1477514958 |
| Last Name Of The Provider | POTTER |
| First Name Of The Provider | ORIE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | PAC MPAS |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1400 E CARROLL |
| Street Address 2 Of The Provider | |
| City Of The Provider | MACOMB |
| Zip Code Of The Provider | 61455 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 806 |
| Number Of Medicare Beneficiaries | 694 |
| Total Submitted Charge Amount | 199111 |
| Total Medicare Allowed Amount | 66434.89 |
| Total Medicare Payment Amount | 51000.49 |
| Total Medicare Standardized Payment Amount | 63399.21 |
| 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 | 24 |
| Number Of Medical Services | 806 |
| Number Of Medicare Beneficiaries With Medical Services | 694 |
| Total Medical Submitted Charge Amount | 199111 |
| Total Medical Medicare Allowed Amount | 66434.89 |
| Total Medical Medicare Payment Amount | 51000.49 |
| Total Medical Medicare Standardized Payment Amount | 63399.21 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 200 |
| Number Of Beneficiaries Age 65 to 74 | 201 |
| Number Of Beneficiaries Age 75 to 84 | 162 |
| Number Of Beneficiaries Age Greater 84 | 131 |
| Number Of Female Beneficiaries | 371 |
| Number Of Male Beneficiaries | 323 |
| Number Of Non Hispanic White Beneficiaries | 639 |
| Number Of Black or African American Beneficiaries | 40 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 475 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 219 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 64 |
| 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 | 11 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4834 |