| National Provider Identifier [NPI]: | 1003964222 |
| Last Name Of The Provider | VLIEGENTHART |
| First Name Of The Provider | DONALD |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 709 S. HARBOR CITY BOULEVARD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | MELBOURNE |
| Zip Code Of The Provider | 329011936 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 1884 |
| Number Of Medicare Beneficiaries | 120 |
| Total Submitted Charge Amount | 516437.52 |
| Total Medicare Allowed Amount | 116017.91 |
| Total Medicare Payment Amount | 86611.94 |
| Total Medicare Standardized Payment Amount | 73594.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 999 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 25477.12 |
| Total Drug Medicare AllowedAmount | 7051.52 |
| Total Drug Medicare PaymentAmount | 5528.18 |
| Total Drug Medicare Standardized Payment Amount | 5528.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 885 |
| Number Of Medicare Beneficiaries With Medical Services | 120 |
| Total Medical Submitted Charge Amount | 490960.4 |
| Total Medical Medicare Allowed Amount | 108966.39 |
| Total Medical Medicare Payment Amount | 81083.76 |
| Total Medical Medicare Standardized Payment Amount | 68066.65 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 44 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 70 |
| Number Of Male Beneficiaries | 50 |
| Number Of Non Hispanic White Beneficiaries | 106 |
| Number Of Black or African American Beneficiaries | |
| 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 | 95 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2193 |