| National Provider Identifier [NPI]: | 1649382995 |
| Last Name Of The Provider | FORREST |
| First Name Of The Provider | THEODORE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 AUDUBON PLAZA DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOUISVILLE |
| Zip Code Of The Provider | 402171318 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 3984 |
| Number Of Medicare Beneficiaries | 2003 |
| Total Submitted Charge Amount | 1562743 |
| Total Medicare Allowed Amount | 316799.34 |
| Total Medicare Payment Amount | 244018.61 |
| Total Medicare Standardized Payment Amount | 254538.07 |
| 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 | 36 |
| Number Of Medical Services | 3984 |
| Number Of Medicare Beneficiaries With Medical Services | 2003 |
| Total Medical Submitted Charge Amount | 1562743 |
| Total Medical Medicare Allowed Amount | 316799.34 |
| Total Medical Medicare Payment Amount | 244018.61 |
| Total Medical Medicare Standardized Payment Amount | 254538.07 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 642 |
| Number Of Beneficiaries Age 65 to 74 | 576 |
| Number Of Beneficiaries Age 75 to 84 | 471 |
| Number Of Beneficiaries Age Greater 84 | 314 |
| Number Of Female Beneficiaries | 1225 |
| Number Of Male Beneficiaries | 778 |
| Number Of Non Hispanic White Beneficiaries | 1655 |
| Number Of Black or African American Beneficiaries | 297 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1275 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 728 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.9909 |