| National Provider Identifier [NPI]: | 1023094349 |
| Last Name Of The Provider | BOTERO |
| First Name Of The Provider | HERMAN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1422 OLD WEISGARBER RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | KNOXVILLE |
| Zip Code Of The Provider | 379091293 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 1257 |
| Number Of Medicare Beneficiaries | 311 |
| Total Submitted Charge Amount | 648685.3 |
| Total Medicare Allowed Amount | 139696.07 |
| Total Medicare Payment Amount | 107463.73 |
| Total Medicare Standardized Payment Amount | 115983.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 420 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 3064 |
| Total Drug Medicare AllowedAmount | 1264.83 |
| Total Drug Medicare PaymentAmount | 989.1 |
| Total Drug Medicare Standardized Payment Amount | 989.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 837 |
| Number Of Medicare Beneficiaries With Medical Services | 311 |
| Total Medical Submitted Charge Amount | 645621.3 |
| Total Medical Medicare Allowed Amount | 138431.24 |
| Total Medical Medicare Payment Amount | 106474.63 |
| Total Medical Medicare Standardized Payment Amount | 114993.97 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 157 |
| Number Of Beneficiaries Age 75 to 84 | 76 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 185 |
| Number Of Male Beneficiaries | 126 |
| Number Of Non Hispanic White Beneficiaries | 293 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 272 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.101 |