| National Provider Identifier [NPI]: | 1477780187 |
| Last Name Of The Provider | MINETT |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 212 HILLCREST AVE |
| Street Address 2 Of The Provider | APARTMENT C |
| City Of The Provider | COLLINGSWOOD |
| Zip Code Of The Provider | 081083843 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 1526 |
| Number Of Medicare Beneficiaries | 875 |
| Total Submitted Charge Amount | 668469.99 |
| Total Medicare Allowed Amount | 166840.03 |
| Total Medicare Payment Amount | 129232.88 |
| Total Medicare Standardized Payment Amount | 120957.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 1526 |
| Number Of Medicare Beneficiaries With Medical Services | 875 |
| Total Medical Submitted Charge Amount | 668469.99 |
| Total Medical Medicare Allowed Amount | 166840.03 |
| Total Medical Medicare Payment Amount | 129232.88 |
| Total Medical Medicare Standardized Payment Amount | 120957.76 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 163 |
| Number Of Beneficiaries Age 65 to 74 | 214 |
| Number Of Beneficiaries Age 75 to 84 | 257 |
| Number Of Beneficiaries Age Greater 84 | 241 |
| Number Of Female Beneficiaries | 520 |
| Number Of Male Beneficiaries | 355 |
| Number Of Non Hispanic White Beneficiaries | 721 |
| Number Of Black or African American Beneficiaries | 70 |
| Number Of AsianPacific Islander Beneficiaries | 27 |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 685 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 190 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 1.9931 |