| National Provider Identifier [NPI]: | 1790705283 |
| Last Name Of The Provider | OTTMAN |
| First Name Of The Provider | ROGER |
| 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 | 1512 12TH AVE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | NAMPA |
| Zip Code Of The Provider | 836866008 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 605 |
| Number Of Medicare Beneficiaries | 375 |
| Total Submitted Charge Amount | 583108 |
| Total Medicare Allowed Amount | 65899.9 |
| Total Medicare Payment Amount | 50788.34 |
| Total Medicare Standardized Payment Amount | 51124.06 |
| 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 | 16 |
| Number Of Medical Services | 605 |
| Number Of Medicare Beneficiaries With Medical Services | 375 |
| Total Medical Submitted Charge Amount | 583108 |
| Total Medical Medicare Allowed Amount | 65899.9 |
| Total Medical Medicare Payment Amount | 50788.34 |
| Total Medical Medicare Standardized Payment Amount | 51124.06 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 65 |
| Number Of Beneficiaries Age 65 to 74 | 104 |
| Number Of Beneficiaries Age 75 to 84 | 117 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 183 |
| Number Of Male Beneficiaries | 192 |
| Number Of Non Hispanic White Beneficiaries | 316 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 290 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 85 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.9913 |