| National Provider Identifier [NPI]: | 1356332720 |
| Last Name Of The Provider | PETIT |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1515 NW 18TH AVE |
| Street Address 2 Of The Provider | #300 |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 972092516 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 98 |
| Number Of Services | 2401 |
| Number Of Medicare Beneficiaries | 389 |
| Total Submitted Charge Amount | 673828 |
| Total Medicare Allowed Amount | 236953.27 |
| Total Medicare Payment Amount | 177195.48 |
| Total Medicare Standardized Payment Amount | 185278.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 485 |
| Number Of Medicare Beneficiaries With Drug Services | 130 |
| Total Drug Submitted ChargeAmount | 26190 |
| Total Drug Medicare AllowedAmount | 14897.96 |
| Total Drug Medicare PaymentAmount | 11536.07 |
| Total Drug Medicare Standardized Payment Amount | 11536.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 95 |
| Number Of Medical Services | 1916 |
| Number Of Medicare Beneficiaries With Medical Services | 389 |
| Total Medical Submitted Charge Amount | 647638 |
| Total Medical Medicare Allowed Amount | 222055.31 |
| Total Medical Medicare Payment Amount | 165659.41 |
| Total Medical Medicare Standardized Payment Amount | 173742.2 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 200 |
| Number Of Beneficiaries Age 75 to 84 | 112 |
| Number Of Beneficiaries Age Greater 84 | 49 |
| Number Of Female Beneficiaries | 241 |
| Number Of Male Beneficiaries | 148 |
| Number Of Non Hispanic White Beneficiaries | 370 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 338 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 63 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8758 |