| National Provider Identifier [NPI]: | 1265468706 |
| Last Name Of The Provider | PETTIJOHN |
| First Name Of The Provider | TRENT |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6300 W PARKER RD |
| Street Address 2 Of The Provider | MOB II 125 |
| City Of The Provider | PLANO |
| Zip Code Of The Provider | 750938100 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 4804 |
| Number Of Medicare Beneficiaries | 1006 |
| Total Submitted Charge Amount | 1107922.51 |
| Total Medicare Allowed Amount | 439439.56 |
| Total Medicare Payment Amount | 322500.11 |
| Total Medicare Standardized Payment Amount | 352658.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 448 |
| Number Of Medicare Beneficiaries With Drug Services | 111 |
| Total Drug Submitted ChargeAmount | 38080 |
| Total Drug Medicare AllowedAmount | 23730.95 |
| Total Drug Medicare PaymentAmount | 17656.79 |
| Total Drug Medicare Standardized Payment Amount | 17656.79 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 69 |
| Number Of Medical Services | 4356 |
| Number Of Medicare Beneficiaries With Medical Services | 1006 |
| Total Medical Submitted Charge Amount | 1069842.51 |
| Total Medical Medicare Allowed Amount | 415708.61 |
| Total Medical Medicare Payment Amount | 304843.32 |
| Total Medical Medicare Standardized Payment Amount | 335001.43 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 466 |
| Number Of Beneficiaries Age 75 to 84 | 339 |
| Number Of Beneficiaries Age Greater 84 | 160 |
| Number Of Female Beneficiaries | 494 |
| Number Of Male Beneficiaries | 512 |
| Number Of Non Hispanic White Beneficiaries | 906 |
| Number Of Black or African American Beneficiaries | 29 |
| Number Of AsianPacific Islander Beneficiaries | 21 |
| 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 | 964 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3231 |