| National Provider Identifier [NPI]: | 1205044146 |
| Last Name Of The Provider | PUCKETT |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2004 N BALTIMORE ST |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | KIRKSVILLE |
| Zip Code Of The Provider | 635015107 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 200 |
| Number Of Services | 13796 |
| Number Of Medicare Beneficiaries | 994 |
| Total Submitted Charge Amount | 869423 |
| Total Medicare Allowed Amount | 420747.16 |
| Total Medicare Payment Amount | 319720.17 |
| Total Medicare Standardized Payment Amount | 341533.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 22 |
| Number Of Drug Services | 2778 |
| Number Of Medicare Beneficiaries With Drug Services | 306 |
| Total Drug Submitted ChargeAmount | 43846 |
| Total Drug Medicare AllowedAmount | 16766.24 |
| Total Drug Medicare PaymentAmount | 13834.69 |
| Total Drug Medicare Standardized Payment Amount | 13834.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 178 |
| Number Of Medical Services | 11018 |
| Number Of Medicare Beneficiaries With Medical Services | 994 |
| Total Medical Submitted Charge Amount | 825577 |
| Total Medical Medicare Allowed Amount | 403980.92 |
| Total Medical Medicare Payment Amount | 305885.48 |
| Total Medical Medicare Standardized Payment Amount | 327698.45 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 287 |
| Number Of Beneficiaries Age 65 to 74 | 378 |
| Number Of Beneficiaries Age 75 to 84 | 223 |
| Number Of Beneficiaries Age Greater 84 | 106 |
| Number Of Female Beneficiaries | 601 |
| Number Of Male Beneficiaries | 393 |
| Number Of Non Hispanic White Beneficiaries | 970 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 714 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 280 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.067 |