| National Provider Identifier [NPI]: | 1255626503 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | BRYANT |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 465 MEMORIAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | POCATELLO |
| Zip Code Of The Provider | 832014008 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 235 |
| Number Of Medicare Beneficiaries | 75 |
| Total Submitted Charge Amount | 17847 |
| Total Medicare Allowed Amount | 12550.8 |
| Total Medicare Payment Amount | 9407.52 |
| Total Medicare Standardized Payment Amount | 9984.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 30 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 739 |
| Total Drug Medicare AllowedAmount | 578.96 |
| Total Drug Medicare PaymentAmount | 560.55 |
| Total Drug Medicare Standardized Payment Amount | 560.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 205 |
| Number Of Medicare Beneficiaries With Medical Services | 75 |
| Total Medical Submitted Charge Amount | 17108 |
| Total Medical Medicare Allowed Amount | 11971.84 |
| Total Medical Medicare Payment Amount | 8846.97 |
| Total Medical Medicare Standardized Payment Amount | 9424.08 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 16 |
| Number Of Beneficiaries Age 65 to 74 | 33 |
| Number Of Beneficiaries Age 75 to 84 | 14 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 44 |
| Number Of Male Beneficiaries | 31 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 63 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8575 |