| National Provider Identifier [NPI]: | 1427099449 |
| Last Name Of The Provider | DETAR |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 13103 E MANSFIELD |
| Street Address 2 Of The Provider | INCYTE PATHOLOGY PS |
| City Of The Provider | SPOKANE |
| Zip Code Of The Provider | 99216 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 3102 |
| Number Of Medicare Beneficiaries | 1015 |
| Total Submitted Charge Amount | 241851 |
| Total Medicare Allowed Amount | 110450.52 |
| Total Medicare Payment Amount | 84051.95 |
| Total Medicare Standardized Payment Amount | 66655.73 |
| 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 | 30 |
| Number Of Medical Services | 3102 |
| Number Of Medicare Beneficiaries With Medical Services | 1015 |
| Total Medical Submitted Charge Amount | 241851 |
| Total Medical Medicare Allowed Amount | 110450.52 |
| Total Medical Medicare Payment Amount | 84051.95 |
| Total Medical Medicare Standardized Payment Amount | 66655.73 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 184 |
| Number Of Beneficiaries Age 65 to 74 | 447 |
| Number Of Beneficiaries Age 75 to 84 | 295 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 562 |
| Number Of Male Beneficiaries | 453 |
| Number Of Non Hispanic White Beneficiaries | 958 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 791 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 224 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2523 |