| National Provider Identifier [NPI]: | 1306880844 |
| Last Name Of The Provider | PEARCE |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1825 S KIMBALL AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CALDWELL |
| Zip Code Of The Provider | 836054828 |
| 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 | 49 |
| Number Of Services | 824 |
| Number Of Medicare Beneficiaries | 212 |
| Total Submitted Charge Amount | 95430.03 |
| Total Medicare Allowed Amount | 44529.41 |
| Total Medicare Payment Amount | 30270.89 |
| Total Medicare Standardized Payment Amount | 33178.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 79 |
| Number Of Medicare Beneficiaries With Drug Services | 43 |
| Total Drug Submitted ChargeAmount | 3945.03 |
| Total Drug Medicare AllowedAmount | 1398.81 |
| Total Drug Medicare PaymentAmount | 1346.48 |
| Total Drug Medicare Standardized Payment Amount | 1346.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 745 |
| Number Of Medicare Beneficiaries With Medical Services | 212 |
| Total Medical Submitted Charge Amount | 91485 |
| Total Medical Medicare Allowed Amount | 43130.6 |
| Total Medical Medicare Payment Amount | 28924.41 |
| Total Medical Medicare Standardized Payment Amount | 31831.85 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 117 |
| Number Of Beneficiaries Age 75 to 84 | 41 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 110 |
| Number Of Male Beneficiaries | 102 |
| Number Of Non Hispanic White Beneficiaries | 188 |
| 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 | 173 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9125 |