| National Provider Identifier [NPI]: | 1134199219 |
| Last Name Of The Provider | HALTER |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 225 HOSPITAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | TYRONE |
| Zip Code Of The Provider | 166861802 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 688 |
| Number Of Medicare Beneficiaries | 175 |
| Total Submitted Charge Amount | 93990.5 |
| Total Medicare Allowed Amount | 49431.73 |
| Total Medicare Payment Amount | 35269.28 |
| Total Medicare Standardized Payment Amount | 37946.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 97 |
| Number Of Medicare Beneficiaries With Drug Services | 87 |
| Total Drug Submitted ChargeAmount | 3881 |
| Total Drug Medicare AllowedAmount | 2350.02 |
| Total Drug Medicare PaymentAmount | 2172.75 |
| Total Drug Medicare Standardized Payment Amount | 2172.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 591 |
| Number Of Medicare Beneficiaries With Medical Services | 175 |
| Total Medical Submitted Charge Amount | 90109.5 |
| Total Medical Medicare Allowed Amount | 47081.71 |
| Total Medical Medicare Payment Amount | 33096.53 |
| Total Medical Medicare Standardized Payment Amount | 35773.29 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 57 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 89 |
| Number Of Male Beneficiaries | 86 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 114 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0558 |