| National Provider Identifier [NPI]: | 1144526963 |
| Last Name Of The Provider | HAERTLING |
| First Name Of The Provider | DEVIN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4121 VETERANS MEMORIAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOUNT VERNON |
| Zip Code Of The Provider | 628646262 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 91 |
| Number Of Services | 10803 |
| Number Of Medicare Beneficiaries | 934 |
| Total Submitted Charge Amount | 1076714.29 |
| Total Medicare Allowed Amount | 256784.5 |
| Total Medicare Payment Amount | 193102.05 |
| Total Medicare Standardized Payment Amount | 209795.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 7561 |
| Number Of Medicare Beneficiaries With Drug Services | 246 |
| Total Drug Submitted ChargeAmount | 154343.49 |
| Total Drug Medicare AllowedAmount | 102880.83 |
| Total Drug Medicare PaymentAmount | 79651.27 |
| Total Drug Medicare Standardized Payment Amount | 79651.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 87 |
| Number Of Medical Services | 3242 |
| Number Of Medicare Beneficiaries With Medical Services | 934 |
| Total Medical Submitted Charge Amount | 922370.8 |
| Total Medical Medicare Allowed Amount | 153903.67 |
| Total Medical Medicare Payment Amount | 113450.78 |
| Total Medical Medicare Standardized Payment Amount | 130144.28 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 243 |
| Number Of Beneficiaries Age 65 to 74 | 356 |
| Number Of Beneficiaries Age 75 to 84 | 221 |
| Number Of Beneficiaries Age Greater 84 | 114 |
| Number Of Female Beneficiaries | 634 |
| Number Of Male Beneficiaries | 300 |
| Number Of Non Hispanic White Beneficiaries | 898 |
| Number Of Black or African American Beneficiaries | 24 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 628 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 306 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 72 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2262 |