| National Provider Identifier [NPI]: | 1801807144 |
| Last Name Of The Provider | BOSEMAN |
| First Name Of The Provider | JERALD |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1960 KEN PRATT BLVD |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | LONGMONT |
| Zip Code Of The Provider | 80501 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 1239 |
| Number Of Medicare Beneficiaries | 349 |
| Total Submitted Charge Amount | 312722 |
| Total Medicare Allowed Amount | 153843.44 |
| Total Medicare Payment Amount | 116421.8 |
| Total Medicare Standardized Payment Amount | 118411.92 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
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| Number Of Medicare Beneficiaries With Medical Services | |
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| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 86 |
| Number Of Beneficiaries Age 65 to 74 | 126 |
| Number Of Beneficiaries Age 75 to 84 | 91 |
| Number Of Beneficiaries Age Greater 84 | 46 |
| Number Of Female Beneficiaries | 174 |
| Number Of Male Beneficiaries | 175 |
| Number Of Non Hispanic White Beneficiaries | 262 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 68 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 254 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 95 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 55 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 3.6897 |