| National Provider Identifier [NPI]: | 1700880580 |
| Last Name Of The Provider | DOTTINO |
| First Name Of The Provider | EZRA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 79 WAWECUS ST |
| Street Address 2 Of The Provider | SUITE 109 |
| City Of The Provider | NORWICH |
| Zip Code Of The Provider | 063602160 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 5538 |
| Number Of Medicare Beneficiaries | 1366 |
| Total Submitted Charge Amount | 309861.92 |
| Total Medicare Allowed Amount | 227954.08 |
| Total Medicare Payment Amount | 171552.68 |
| Total Medicare Standardized Payment Amount | 158781.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 171 |
| Total Drug Medicare AllowedAmount | 16.95 |
| Total Drug Medicare PaymentAmount | 13.29 |
| Total Drug Medicare Standardized Payment Amount | 13.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 5523 |
| Number Of Medicare Beneficiaries With Medical Services | 1366 |
| Total Medical Submitted Charge Amount | 309690.92 |
| Total Medical Medicare Allowed Amount | 227937.13 |
| Total Medical Medicare Payment Amount | 171539.39 |
| Total Medical Medicare Standardized Payment Amount | 158767.73 |
| Average Age Of Beneficiaries | 82 |
| Number Of Beneficiaries Age Less65 | 103 |
| Number Of Beneficiaries Age 65 to 74 | 192 |
| Number Of Beneficiaries Age 75 to 84 | 421 |
| Number Of Beneficiaries Age Greater 84 | 650 |
| Number Of Female Beneficiaries | 930 |
| Number Of Male Beneficiaries | 436 |
| Number Of Non Hispanic White Beneficiaries | 1273 |
| Number Of Black or African American Beneficiaries | 44 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 784 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 582 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 51 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7089 |