| National Provider Identifier [NPI]: | 1407937253 |
| Last Name Of The Provider | PETTIT |
| First Name Of The Provider | JOHN |
| 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 | 340 BIRCHWOOD AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BELLINGHAM |
| Zip Code Of The Provider | 982251782 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 77 |
| Number Of Services | 2608 |
| Number Of Medicare Beneficiaries | 641 |
| Total Submitted Charge Amount | 684401 |
| Total Medicare Allowed Amount | 264920.02 |
| Total Medicare Payment Amount | 198660.09 |
| Total Medicare Standardized Payment Amount | 201375.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 152 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 139515 |
| Total Drug Medicare AllowedAmount | 65587.19 |
| Total Drug Medicare PaymentAmount | 51216.55 |
| Total Drug Medicare Standardized Payment Amount | 51216.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 74 |
| Number Of Medical Services | 2456 |
| Number Of Medicare Beneficiaries With Medical Services | 641 |
| Total Medical Submitted Charge Amount | 544886 |
| Total Medical Medicare Allowed Amount | 199332.83 |
| Total Medical Medicare Payment Amount | 147443.54 |
| Total Medical Medicare Standardized Payment Amount | 150159.2 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 240 |
| Number Of Beneficiaries Age 75 to 84 | 214 |
| Number Of Beneficiaries Age Greater 84 | 132 |
| Number Of Female Beneficiaries | 114 |
| Number Of Male Beneficiaries | 527 |
| Number Of Non Hispanic White Beneficiaries | 573 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 19 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 545 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 96 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2668 |