| National Provider Identifier [NPI]: | 1619048709 |
| Last Name Of The Provider | GOTTESMAN |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1135 116TH AVE NE |
| Street Address 2 Of The Provider | SUITE 600 |
| City Of The Provider | BELLEVUE |
| Zip Code Of The Provider | 980044623 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Critical Care (Intensivists) |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 639 |
| Number Of Medicare Beneficiaries | 268 |
| Total Submitted Charge Amount | 534821 |
| Total Medicare Allowed Amount | 109417.58 |
| Total Medicare Payment Amount | 85451.07 |
| Total Medicare Standardized Payment Amount | 75900.03 |
| 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 | 18 |
| Number Of Medical Services | 639 |
| Number Of Medicare Beneficiaries With Medical Services | 268 |
| Total Medical Submitted Charge Amount | 534821 |
| Total Medical Medicare Allowed Amount | 109417.58 |
| Total Medical Medicare Payment Amount | 85451.07 |
| Total Medical Medicare Standardized Payment Amount | 75900.03 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 72 |
| Number Of Beneficiaries Age 75 to 84 | 75 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 132 |
| Number Of Male Beneficiaries | 136 |
| Number Of Non Hispanic White Beneficiaries | 184 |
| Number Of Black or African American Beneficiaries | 25 |
| Number Of AsianPacific Islander Beneficiaries | 27 |
| 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 | 172 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 96 |
| Percent Of With Atrial Fibrillation | 35 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 62 |
| Percent Of With Chronic Kidney Disease | 70 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 57 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 24 |
| Average HCC Risk Score Of Beneficiaries | 3.0324 |