| National Provider Identifier [NPI]: | 1922007582 |
| Last Name Of The Provider | PUCCI |
| First Name Of The Provider | ANTHONY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 416 CONNABLE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PETOSKEY |
| Zip Code Of The Provider | 497702212 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 201 |
| Number Of Services | 4967 |
| Number Of Medicare Beneficiaries | 3213 |
| Total Submitted Charge Amount | 452877.11 |
| Total Medicare Allowed Amount | 164546.96 |
| Total Medicare Payment Amount | 128907.6 |
| Total Medicare Standardized Payment Amount | 133184.49 |
| 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 | 201 |
| Number Of Medical Services | 4967 |
| Number Of Medicare Beneficiaries With Medical Services | 3213 |
| Total Medical Submitted Charge Amount | 452877.11 |
| Total Medical Medicare Allowed Amount | 164546.96 |
| Total Medical Medicare Payment Amount | 128907.6 |
| Total Medical Medicare Standardized Payment Amount | 133184.49 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 577 |
| Number Of Beneficiaries Age 65 to 74 | 1304 |
| Number Of Beneficiaries Age 75 to 84 | 912 |
| Number Of Beneficiaries Age Greater 84 | 420 |
| Number Of Female Beneficiaries | 1929 |
| Number Of Male Beneficiaries | 1284 |
| Number Of Non Hispanic White Beneficiaries | 3061 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 96 |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2470 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 743 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3109 |