| National Provider Identifier [NPI]: | 1649251174 |
| Last Name Of The Provider | DERUSSY |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2115 LEITER RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MIAMISBURG |
| Zip Code Of The Provider | 453423659 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 1144 |
| Number Of Medicare Beneficiaries | 301 |
| Total Submitted Charge Amount | 125584 |
| Total Medicare Allowed Amount | 74350.93 |
| Total Medicare Payment Amount | 52662.56 |
| Total Medicare Standardized Payment Amount | 54971.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 100 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 2772 |
| Total Drug Medicare AllowedAmount | 1311.77 |
| Total Drug Medicare PaymentAmount | 1216 |
| Total Drug Medicare Standardized Payment Amount | 1216 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 1044 |
| Number Of Medicare Beneficiaries With Medical Services | 301 |
| Total Medical Submitted Charge Amount | 122812 |
| Total Medical Medicare Allowed Amount | 73039.16 |
| Total Medical Medicare Payment Amount | 51446.56 |
| Total Medical Medicare Standardized Payment Amount | 53755.23 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 82 |
| Number Of Beneficiaries Age 65 to 74 | 106 |
| Number Of Beneficiaries Age 75 to 84 | 71 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 151 |
| Number Of Male Beneficiaries | 150 |
| Number Of Non Hispanic White Beneficiaries | 269 |
| Number Of Black or African American Beneficiaries | 19 |
| 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 | 218 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 83 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.6095 |