| National Provider Identifier [NPI]: | 1265422752 |
| Last Name Of The Provider | BORNHOLDT |
| First Name Of The Provider | AMY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1100 N SAINT FRANCIS ST |
| Street Address 2 Of The Provider | SUITE 130 |
| City Of The Provider | WICHITA |
| Zip Code Of The Provider | 672142878 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 937 |
| Number Of Medicare Beneficiaries | 427 |
| Total Submitted Charge Amount | 100865 |
| Total Medicare Allowed Amount | 62192.97 |
| Total Medicare Payment Amount | 47966.63 |
| Total Medicare Standardized Payment Amount | 60879.27 |
| 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 | 15 |
| Number Of Medical Services | 937 |
| Number Of Medicare Beneficiaries With Medical Services | 427 |
| Total Medical Submitted Charge Amount | 100865 |
| Total Medical Medicare Allowed Amount | 62192.97 |
| Total Medical Medicare Payment Amount | 47966.63 |
| Total Medical Medicare Standardized Payment Amount | 60879.27 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 116 |
| Number Of Beneficiaries Age 65 to 74 | 133 |
| Number Of Beneficiaries Age 75 to 84 | 103 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 226 |
| Number Of Male Beneficiaries | 201 |
| Number Of Non Hispanic White Beneficiaries | 386 |
| Number Of Black or African American Beneficiaries | 17 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 287 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 140 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 54 |
| Percent Of With Chronic Kidney Disease | 66 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 41 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 58 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 3.0346 |