| National Provider Identifier [NPI]: | 1568424661 |
| Last Name Of The Provider | OTIS |
| First Name Of The Provider | SHIRLEY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10666 N TORREY PINES RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LA JOLLA |
| Zip Code Of The Provider | 920371027 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 1920 |
| Number Of Medicare Beneficiaries | 1481 |
| Total Submitted Charge Amount | 820029 |
| Total Medicare Allowed Amount | 279513.28 |
| Total Medicare Payment Amount | 210090.09 |
| Total Medicare Standardized Payment Amount | 200132.38 |
| 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 | 18 |
| Number Of Medical Services | 1920 |
| Number Of Medicare Beneficiaries With Medical Services | 1481 |
| Total Medical Submitted Charge Amount | 820029 |
| Total Medical Medicare Allowed Amount | 279513.28 |
| Total Medical Medicare Payment Amount | 210090.09 |
| Total Medical Medicare Standardized Payment Amount | 200132.38 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 580 |
| Number Of Beneficiaries Age 75 to 84 | 495 |
| Number Of Beneficiaries Age Greater 84 | 307 |
| Number Of Female Beneficiaries | 770 |
| Number Of Male Beneficiaries | 711 |
| Number Of Non Hispanic White Beneficiaries | 1255 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 75 |
| Number Of Hispanic Beneficiaries | 86 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1319 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 162 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7154 |