| National Provider Identifier [NPI]: | 1922021476 |
| Last Name Of The Provider | PETRACO |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6 TECHNOLOGY DR |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | EAST SETAUKET |
| Zip Code Of The Provider | 117334047 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 5791 |
| Number Of Medicare Beneficiaries | 922 |
| Total Submitted Charge Amount | 6040237.66 |
| Total Medicare Allowed Amount | 617831.04 |
| Total Medicare Payment Amount | 462135.27 |
| Total Medicare Standardized Payment Amount | 404697.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 1215 |
| Number Of Medicare Beneficiaries With Drug Services | 463 |
| Total Drug Submitted ChargeAmount | 86299.2 |
| Total Drug Medicare AllowedAmount | 35084.14 |
| Total Drug Medicare PaymentAmount | 26448.38 |
| Total Drug Medicare Standardized Payment Amount | 26448.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 65 |
| Number Of Medical Services | 4576 |
| Number Of Medicare Beneficiaries With Medical Services | 922 |
| Total Medical Submitted Charge Amount | 5953938.46 |
| Total Medical Medicare Allowed Amount | 582746.9 |
| Total Medical Medicare Payment Amount | 435686.89 |
| Total Medical Medicare Standardized Payment Amount | 378248.91 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 441 |
| Number Of Beneficiaries Age 75 to 84 | 291 |
| Number Of Beneficiaries Age Greater 84 | 110 |
| Number Of Female Beneficiaries | 613 |
| Number Of Male Beneficiaries | 309 |
| Number Of Non Hispanic White Beneficiaries | 850 |
| Number Of Black or African American Beneficiaries | 21 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 868 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1822 |