| National Provider Identifier [NPI]: | 1003878083 |
| Last Name Of The Provider | GOTTLOB |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 660 GOLDEN RIDGE RD |
| Street Address 2 Of The Provider | SUITE 250 |
| City Of The Provider | GOLDEN |
| Zip Code Of The Provider | 804019541 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Sports Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 2039 |
| Number Of Medicare Beneficiaries | 274 |
| Total Submitted Charge Amount | 389007.25 |
| Total Medicare Allowed Amount | 155753.37 |
| Total Medicare Payment Amount | 115939.93 |
| Total Medicare Standardized Payment Amount | 114844.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 989 |
| Number Of Medicare Beneficiaries With Drug Services | 137 |
| Total Drug Submitted ChargeAmount | 49062 |
| Total Drug Medicare AllowedAmount | 30965.54 |
| Total Drug Medicare PaymentAmount | 24087.29 |
| Total Drug Medicare Standardized Payment Amount | 24087.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 1050 |
| Number Of Medicare Beneficiaries With Medical Services | 274 |
| Total Medical Submitted Charge Amount | 339945.25 |
| Total Medical Medicare Allowed Amount | 124787.83 |
| Total Medical Medicare Payment Amount | 91852.64 |
| Total Medical Medicare Standardized Payment Amount | 90757.08 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 169 |
| Number Of Beneficiaries Age 75 to 84 | 66 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 132 |
| Number Of Male Beneficiaries | 142 |
| Number Of Non Hispanic White Beneficiaries | 251 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 256 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 72 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9279 |