| National Provider Identifier [NPI]: | 1912952219 |
| Last Name Of The Provider | KOTH |
| First Name Of The Provider | SHAUN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | P.T. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 16222 N 59TH AVE |
| Street Address 2 Of The Provider | SUITE A100 |
| City Of The Provider | GLENDALE |
| Zip Code Of The Provider | 853061701 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Therapist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 4795 |
| Number Of Medicare Beneficiaries | 173 |
| Total Submitted Charge Amount | 230753 |
| Total Medicare Allowed Amount | 124940.94 |
| Total Medicare Payment Amount | 96132.07 |
| Total Medicare Standardized Payment Amount | 76582.95 |
| 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 | 11 |
| Number Of Medical Services | 4795 |
| Number Of Medicare Beneficiaries With Medical Services | 173 |
| Total Medical Submitted Charge Amount | 230753 |
| Total Medical Medicare Allowed Amount | 124940.94 |
| Total Medical Medicare Payment Amount | 96132.07 |
| Total Medical Medicare Standardized Payment Amount | 76582.95 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 101 |
| Number Of Beneficiaries Age 75 to 84 | 48 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 97 |
| Number Of Male Beneficiaries | 76 |
| Number Of Non Hispanic White Beneficiaries | 146 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| 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 | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8935 |