| National Provider Identifier [NPI]: | 1174539555 |
| Last Name Of The Provider | WILLATS |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2 W 42ND ST |
| Street Address 2 Of The Provider | STE 2700 |
| City Of The Provider | SCOTTSBLUFF |
| Zip Code Of The Provider | 693614669 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 6513 |
| Number Of Medicare Beneficiaries | 1736 |
| Total Submitted Charge Amount | 402067 |
| Total Medicare Allowed Amount | 294990.4 |
| Total Medicare Payment Amount | 213323.81 |
| Total Medicare Standardized Payment Amount | 235377.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 960 |
| Total Drug Medicare AllowedAmount | 35.73 |
| Total Drug Medicare PaymentAmount | 23.75 |
| Total Drug Medicare Standardized Payment Amount | 23.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 6493 |
| Number Of Medicare Beneficiaries With Medical Services | 1736 |
| Total Medical Submitted Charge Amount | 401107 |
| Total Medical Medicare Allowed Amount | 294954.67 |
| Total Medical Medicare Payment Amount | 213300.06 |
| Total Medical Medicare Standardized Payment Amount | 235353.42 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 195 |
| Number Of Beneficiaries Age 65 to 74 | 421 |
| Number Of Beneficiaries Age 75 to 84 | 598 |
| Number Of Beneficiaries Age Greater 84 | 522 |
| Number Of Female Beneficiaries | 1074 |
| Number Of Male Beneficiaries | 662 |
| Number Of Non Hispanic White Beneficiaries | 1580 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 112 |
| Number Of American Indian Alaska Native Beneficiaries | 22 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1231 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 505 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.4316 |