| National Provider Identifier [NPI]: | 1346467693 |
| Last Name Of The Provider | OTTO |
| First Name Of The Provider | NICHOLAS |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 629 D LOWTHER ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LEWISBERRY |
| Zip Code Of The Provider | 173399527 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 168 |
| Number Of Services | 4355 |
| Number Of Medicare Beneficiaries | 3054 |
| Total Submitted Charge Amount | 514863 |
| Total Medicare Allowed Amount | 132783.95 |
| Total Medicare Payment Amount | 102258.38 |
| Total Medicare Standardized Payment Amount | 105849.03 |
| 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 | 168 |
| Number Of Medical Services | 4355 |
| Number Of Medicare Beneficiaries With Medical Services | 3054 |
| Total Medical Submitted Charge Amount | 514863 |
| Total Medical Medicare Allowed Amount | 132783.95 |
| Total Medical Medicare Payment Amount | 102258.38 |
| Total Medical Medicare Standardized Payment Amount | 105849.03 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 456 |
| Number Of Beneficiaries Age 65 to 74 | 997 |
| Number Of Beneficiaries Age 75 to 84 | 943 |
| Number Of Beneficiaries Age Greater 84 | 658 |
| Number Of Female Beneficiaries | 2001 |
| Number Of Male Beneficiaries | 1053 |
| Number Of Non Hispanic White Beneficiaries | 2787 |
| Number Of Black or African American Beneficiaries | 179 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2481 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 573 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.6165 |