| National Provider Identifier [NPI]: | 1386811263 |
| Last Name Of The Provider | POTTER |
| First Name Of The Provider | ANDREW |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3707 NEW VISION DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468451702 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 228 |
| Number Of Services | 7513 |
| Number Of Medicare Beneficiaries | 4921 |
| Total Submitted Charge Amount | 1101793 |
| Total Medicare Allowed Amount | 311076.36 |
| Total Medicare Payment Amount | 235541.06 |
| Total Medicare Standardized Payment Amount | 245461.37 |
| 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 | 228 |
| Number Of Medical Services | 7513 |
| Number Of Medicare Beneficiaries With Medical Services | 4921 |
| Total Medical Submitted Charge Amount | 1101793 |
| Total Medical Medicare Allowed Amount | 311076.36 |
| Total Medical Medicare Payment Amount | 235541.06 |
| Total Medical Medicare Standardized Payment Amount | 245461.37 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1137 |
| Number Of Beneficiaries Age 65 to 74 | 1562 |
| Number Of Beneficiaries Age 75 to 84 | 1396 |
| Number Of Beneficiaries Age Greater 84 | 826 |
| Number Of Female Beneficiaries | 2955 |
| Number Of Male Beneficiaries | 1966 |
| Number Of Non Hispanic White Beneficiaries | 4574 |
| Number Of Black or African American Beneficiaries | 206 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 82 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 41 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3517 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1404 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.6411 |