| National Provider Identifier [NPI]: | 1912902107 |
| Last Name Of The Provider | PETTUS |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1267 HIGHWAY 54 W |
| Street Address 2 Of The Provider | STE 2200 |
| City Of The Provider | FAYETTEVILLE |
| Zip Code Of The Provider | 302142114 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 60 |
| Number Of Services | 9689 |
| Number Of Medicare Beneficiaries | 3014 |
| Total Submitted Charge Amount | 1261121 |
| Total Medicare Allowed Amount | 403531.38 |
| Total Medicare Payment Amount | 289148.51 |
| Total Medicare Standardized Payment Amount | 297286.17 |
| 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 | 60 |
| Number Of Medical Services | 9689 |
| Number Of Medicare Beneficiaries With Medical Services | 3014 |
| Total Medical Submitted Charge Amount | 1261121 |
| Total Medical Medicare Allowed Amount | 403531.38 |
| Total Medical Medicare Payment Amount | 289148.51 |
| Total Medical Medicare Standardized Payment Amount | 297286.17 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 334 |
| Number Of Beneficiaries Age 65 to 74 | 1141 |
| Number Of Beneficiaries Age 75 to 84 | 1023 |
| Number Of Beneficiaries Age Greater 84 | 516 |
| Number Of Female Beneficiaries | 1547 |
| Number Of Male Beneficiaries | 1467 |
| Number Of Non Hispanic White Beneficiaries | 2441 |
| Number Of Black or African American Beneficiaries | 500 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2614 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 400 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5701 |