| National Provider Identifier [NPI]: | 1073591764 |
| Last Name Of The Provider | PRENTISS |
| First Name Of The Provider | R |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | PT,OCS,CERT.MDT,CSCS |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 763 LARKFIELD RD |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | COMMACK |
| Zip Code Of The Provider | 117253131 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Therapist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 5744 |
| Number Of Medicare Beneficiaries | 117 |
| Total Submitted Charge Amount | 192682.41 |
| Total Medicare Allowed Amount | 157576.51 |
| Total Medicare Payment Amount | 122931.9 |
| Total Medicare Standardized Payment Amount | 91356.39 |
| 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 | 9 |
| Number Of Medical Services | 5744 |
| Number Of Medicare Beneficiaries With Medical Services | 117 |
| Total Medical Submitted Charge Amount | 192682.41 |
| Total Medical Medicare Allowed Amount | 157576.51 |
| Total Medical Medicare Payment Amount | 122931.9 |
| Total Medical Medicare Standardized Payment Amount | 91356.39 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 44 |
| Number Of Beneficiaries Age 75 to 84 | 43 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 60 |
| Number Of Male Beneficiaries | 57 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1086 |