| National Provider Identifier [NPI]: | 1235393117 |
| Last Name Of The Provider | TETTIS |
| First Name Of The Provider | DANIELLE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 HOSPITAL AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | DU BOIS |
| Zip Code Of The Provider | 158011440 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 16880 |
| Number Of Medicare Beneficiaries | 338 |
| Total Submitted Charge Amount | 269671.75 |
| Total Medicare Allowed Amount | 136599.13 |
| Total Medicare Payment Amount | 105450.83 |
| Total Medicare Standardized Payment Amount | 112083.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 26 |
| Number Of Drug Services | 16050 |
| Number Of Medicare Beneficiaries With Drug Services | 80 |
| Total Drug Submitted ChargeAmount | 176625.75 |
| Total Drug Medicare AllowedAmount | 95675.48 |
| Total Drug Medicare PaymentAmount | 74957.21 |
| Total Drug Medicare Standardized Payment Amount | 74957.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 830 |
| Number Of Medicare Beneficiaries With Medical Services | 338 |
| Total Medical Submitted Charge Amount | 93046 |
| Total Medical Medicare Allowed Amount | 40923.65 |
| Total Medical Medicare Payment Amount | 30493.62 |
| Total Medical Medicare Standardized Payment Amount | 37126.62 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 124 |
| Number Of Beneficiaries Age 75 to 84 | 131 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 209 |
| Number Of Male Beneficiaries | 129 |
| 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 | 295 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 43 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 49 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.8362 |