| National Provider Identifier [NPI]: | 1770596959 |
| Last Name Of The Provider | PETTUS |
| First Name Of The Provider | BENJAMIN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D., PHD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 J. CLYDE MORRIS BLVD |
| Street Address 2 Of The Provider | RIVERSIDE REGIONAL MEDICAL CENTER |
| City Of The Provider | NEWPORT NEWS |
| Zip Code Of The Provider | 236011929 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 194 |
| Number Of Services | 5654 |
| Number Of Medicare Beneficiaries | 4296 |
| Total Submitted Charge Amount | 667011 |
| Total Medicare Allowed Amount | 185869.2 |
| Total Medicare Payment Amount | 146073.47 |
| Total Medicare Standardized Payment Amount | 150666.13 |
| 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 | 194 |
| Number Of Medical Services | 5654 |
| Number Of Medicare Beneficiaries With Medical Services | 4296 |
| Total Medical Submitted Charge Amount | 667011 |
| Total Medical Medicare Allowed Amount | 185869.2 |
| Total Medical Medicare Payment Amount | 146073.47 |
| Total Medical Medicare Standardized Payment Amount | 150666.13 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 532 |
| Number Of Beneficiaries Age 65 to 74 | 1829 |
| Number Of Beneficiaries Age 75 to 84 | 1337 |
| Number Of Beneficiaries Age Greater 84 | 598 |
| Number Of Female Beneficiaries | 3021 |
| Number Of Male Beneficiaries | 1275 |
| Number Of Non Hispanic White Beneficiaries | 3267 |
| Number Of Black or African American Beneficiaries | 890 |
| Number Of AsianPacific Islander Beneficiaries | 47 |
| Number Of Hispanic Beneficiaries | 49 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3660 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 636 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3622 |