| National Provider Identifier [NPI]: | 1073565008 |
| Last Name Of The Provider | PETTY |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2200 RANDALLIA DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468054638 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 182 |
| Number Of Services | 5814 |
| Number Of Medicare Beneficiaries | 3639 |
| Total Submitted Charge Amount | 729205 |
| Total Medicare Allowed Amount | 266830.96 |
| Total Medicare Payment Amount | 221285.33 |
| Total Medicare Standardized Payment Amount | 237152.05 |
| 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 | 182 |
| Number Of Medical Services | 5814 |
| Number Of Medicare Beneficiaries With Medical Services | 3639 |
| Total Medical Submitted Charge Amount | 729205 |
| Total Medical Medicare Allowed Amount | 266830.96 |
| Total Medical Medicare Payment Amount | 221285.33 |
| Total Medical Medicare Standardized Payment Amount | 237152.05 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 712 |
| Number Of Beneficiaries Age 65 to 74 | 1460 |
| Number Of Beneficiaries Age 75 to 84 | 977 |
| Number Of Beneficiaries Age Greater 84 | 490 |
| Number Of Female Beneficiaries | 2659 |
| Number Of Male Beneficiaries | 980 |
| Number Of Non Hispanic White Beneficiaries | 3386 |
| Number Of Black or African American Beneficiaries | 143 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 56 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2741 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 898 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3237 |