| National Provider Identifier [NPI]: | 1003095548 |
| Last Name Of The Provider | MALLARD |
| First Name Of The Provider | BRADSHAW |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 21801 GODDARD RD |
| Street Address 2 Of The Provider | WSUPG PM&R OAKWOOD |
| City Of The Provider | TAYLOR |
| Zip Code Of The Provider | 481804213 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 3 |
| Number Of Services | 758 |
| Number Of Medicare Beneficiaries | 421 |
| Total Submitted Charge Amount | 115468 |
| Total Medicare Allowed Amount | 49477.16 |
| Total Medicare Payment Amount | 38462.62 |
| Total Medicare Standardized Payment Amount | 44048.77 |
| 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 | 3 |
| Number Of Medical Services | 758 |
| Number Of Medicare Beneficiaries With Medical Services | 421 |
| Total Medical Submitted Charge Amount | 115468 |
| Total Medical Medicare Allowed Amount | 49477.16 |
| Total Medical Medicare Payment Amount | 38462.62 |
| Total Medical Medicare Standardized Payment Amount | 44048.77 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 108 |
| Number Of Beneficiaries Age 75 to 84 | 125 |
| Number Of Beneficiaries Age Greater 84 | 125 |
| Number Of Female Beneficiaries | 252 |
| Number Of Male Beneficiaries | 169 |
| Number Of Non Hispanic White Beneficiaries | 322 |
| Number Of Black or African American Beneficiaries | 70 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 271 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 150 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 52 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 64 |
| Percent Of With Chronic Kidney Disease | 63 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 55 |
| Percent Of With Depression | 62 |
| Percent Of With Diabetes | 60 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 21 |
| Percent Of With Stroke | 21 |
| Average HCC Risk Score Of Beneficiaries | 3.0368 |