| National Provider Identifier [NPI]: | 1154438315 |
| Last Name Of The Provider | PETTY |
| First Name Of The Provider | GRANT |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5221 US ROUTE 60 EAST |
| Street Address 2 Of The Provider | |
| City Of The Provider | HUNTINGTON |
| Zip Code Of The Provider | 257052022 |
| State Code Of The Provider | WV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 199 |
| Number Of Services | 12183 |
| Number Of Medicare Beneficiaries | 4926 |
| Total Submitted Charge Amount | 1009905 |
| Total Medicare Allowed Amount | 238143.27 |
| Total Medicare Payment Amount | 174400.91 |
| Total Medicare Standardized Payment Amount | 189105.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 4050 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 2025 |
| Total Drug Medicare AllowedAmount | 688.73 |
| Total Drug Medicare PaymentAmount | 523.51 |
| Total Drug Medicare Standardized Payment Amount | 523.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 198 |
| Number Of Medical Services | 8133 |
| Number Of Medicare Beneficiaries With Medical Services | 4926 |
| Total Medical Submitted Charge Amount | 1007880 |
| Total Medical Medicare Allowed Amount | 237454.54 |
| Total Medical Medicare Payment Amount | 173877.4 |
| Total Medical Medicare Standardized Payment Amount | 188582.38 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 1571 |
| Number Of Beneficiaries Age 65 to 74 | 1785 |
| Number Of Beneficiaries Age 75 to 84 | 1100 |
| Number Of Beneficiaries Age Greater 84 | 470 |
| Number Of Female Beneficiaries | 2893 |
| Number Of Male Beneficiaries | 2033 |
| Number Of Non Hispanic White Beneficiaries | 4781 |
| Number Of Black or African American Beneficiaries | 96 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2922 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2004 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6083 |