| National Provider Identifier [NPI]: | 1376625004 |
| Last Name Of The Provider | PETYN |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4318 MISSION AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | OCEANSIDE |
| Zip Code Of The Provider | 920576541 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 1208 |
| Number Of Medicare Beneficiaries | 297 |
| Total Submitted Charge Amount | 204980.63 |
| Total Medicare Allowed Amount | 102699.6 |
| Total Medicare Payment Amount | 73162.83 |
| Total Medicare Standardized Payment Amount | 70477.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 126 |
| Number Of Medicare Beneficiaries With Drug Services | 81 |
| Total Drug Submitted ChargeAmount | 8576 |
| Total Drug Medicare AllowedAmount | 4200.5 |
| Total Drug Medicare PaymentAmount | 4105.64 |
| Total Drug Medicare Standardized Payment Amount | 4105.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 1082 |
| Number Of Medicare Beneficiaries With Medical Services | 297 |
| Total Medical Submitted Charge Amount | 196404.63 |
| Total Medical Medicare Allowed Amount | 98499.1 |
| Total Medical Medicare Payment Amount | 69057.19 |
| Total Medical Medicare Standardized Payment Amount | 66371.4 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 133 |
| Number Of Beneficiaries Age 75 to 84 | 96 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 160 |
| Number Of Male Beneficiaries | 137 |
| Number Of Non Hispanic White Beneficiaries | 220 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 256 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1558 |