| National Provider Identifier [NPI]: | 1063486967 |
| Last Name Of The Provider | PUTLAND |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10852 WARWICK BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEWPORT NEWS |
| Zip Code Of The Provider | 236013741 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 101 |
| Number Of Services | 4140 |
| Number Of Medicare Beneficiaries | 368 |
| Total Submitted Charge Amount | 214617 |
| Total Medicare Allowed Amount | 130485.95 |
| Total Medicare Payment Amount | 100451.21 |
| Total Medicare Standardized Payment Amount | 104379.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 141 |
| Number Of Medicare Beneficiaries With Drug Services | 119 |
| Total Drug Submitted ChargeAmount | 5633 |
| Total Drug Medicare AllowedAmount | 4346.2 |
| Total Drug Medicare PaymentAmount | 4200.15 |
| Total Drug Medicare Standardized Payment Amount | 4200.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 3999 |
| Number Of Medicare Beneficiaries With Medical Services | 368 |
| Total Medical Submitted Charge Amount | 208984 |
| Total Medical Medicare Allowed Amount | 126139.75 |
| Total Medical Medicare Payment Amount | 96251.06 |
| Total Medical Medicare Standardized Payment Amount | 100179.62 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 158 |
| Number Of Beneficiaries Age 75 to 84 | 107 |
| Number Of Beneficiaries Age Greater 84 | 46 |
| Number Of Female Beneficiaries | 220 |
| Number Of Male Beneficiaries | 148 |
| Number Of Non Hispanic White Beneficiaries | 280 |
| Number Of Black or African American Beneficiaries | 73 |
| 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 | 321 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0629 |