| National Provider Identifier [NPI]: | 1992760557 |
| Last Name Of The Provider | OTHEGUY |
| First Name Of The Provider | JUAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2035 LITTLE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TRINITY |
| Zip Code Of The Provider | 346554421 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 88 |
| Number Of Services | 6394 |
| Number Of Medicare Beneficiaries | 843 |
| Total Submitted Charge Amount | 737340 |
| Total Medicare Allowed Amount | 329308.31 |
| Total Medicare Payment Amount | 246324.48 |
| Total Medicare Standardized Payment Amount | 249452.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 411 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 70746 |
| Total Drug Medicare AllowedAmount | 34265.73 |
| Total Drug Medicare PaymentAmount | 26418.31 |
| Total Drug Medicare Standardized Payment Amount | 26418.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 83 |
| Number Of Medical Services | 5983 |
| Number Of Medicare Beneficiaries With Medical Services | 843 |
| Total Medical Submitted Charge Amount | 666594 |
| Total Medical Medicare Allowed Amount | 295042.58 |
| Total Medical Medicare Payment Amount | 219906.17 |
| Total Medical Medicare Standardized Payment Amount | 223034.67 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 292 |
| Number Of Beneficiaries Age 75 to 84 | 336 |
| Number Of Beneficiaries Age Greater 84 | 162 |
| Number Of Female Beneficiaries | 257 |
| Number Of Male Beneficiaries | 586 |
| Number Of Non Hispanic White Beneficiaries | 751 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 59 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 784 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3848 |