| National Provider Identifier [NPI]: | 1003993916 |
| Last Name Of The Provider | SHELLEY |
| First Name Of The Provider | AMANDA |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2196 E WILLIAMS FIELD RD |
| Street Address 2 Of The Provider | #116 |
| City Of The Provider | GILBERT |
| Zip Code Of The Provider | 852950754 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 702 |
| Number Of Medicare Beneficiaries | 199 |
| Total Submitted Charge Amount | 89197.37 |
| Total Medicare Allowed Amount | 75775.42 |
| Total Medicare Payment Amount | 56695.15 |
| Total Medicare Standardized Payment Amount | 67545.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 13 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 290 |
| Total Drug Medicare AllowedAmount | 236.03 |
| Total Drug Medicare PaymentAmount | 231.31 |
| Total Drug Medicare Standardized Payment Amount | 231.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 689 |
| Number Of Medicare Beneficiaries With Medical Services | 199 |
| Total Medical Submitted Charge Amount | 88907.37 |
| Total Medical Medicare Allowed Amount | 75539.39 |
| Total Medical Medicare Payment Amount | 56463.84 |
| Total Medical Medicare Standardized Payment Amount | 67314.22 |
| Average Age Of Beneficiaries | 85 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 48 |
| Number Of Beneficiaries Age Greater 84 | 124 |
| Number Of Female Beneficiaries | 135 |
| Number Of Male Beneficiaries | 64 |
| Number Of Non Hispanic White Beneficiaries | 187 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 72 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 62 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.7455 |