| National Provider Identifier [NPI]: | 1639167943 |
| Last Name Of The Provider | LIEBETREU |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | OD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6091 S POINTE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FT MYERS |
| Zip Code Of The Provider | 339194899 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 5220 |
| Number Of Medicare Beneficiaries | 3033 |
| Total Submitted Charge Amount | 624788 |
| Total Medicare Allowed Amount | 531220.65 |
| Total Medicare Payment Amount | 360566.75 |
| Total Medicare Standardized Payment Amount | 344652.91 |
| 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 | 25 |
| Number Of Medical Services | 5220 |
| Number Of Medicare Beneficiaries With Medical Services | 3033 |
| Total Medical Submitted Charge Amount | 624788 |
| Total Medical Medicare Allowed Amount | 531220.65 |
| Total Medical Medicare Payment Amount | 360566.75 |
| Total Medical Medicare Standardized Payment Amount | 344652.91 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 82 |
| Number Of Beneficiaries Age 65 to 74 | 1105 |
| Number Of Beneficiaries Age 75 to 84 | 1240 |
| Number Of Beneficiaries Age Greater 84 | 606 |
| Number Of Female Beneficiaries | 1796 |
| Number Of Male Beneficiaries | 1237 |
| Number Of Non Hispanic White Beneficiaries | 2849 |
| Number Of Black or African American Beneficiaries | 47 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 83 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2882 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 151 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0977 |