| National Provider Identifier [NPI]: | 1447264841 |
| Last Name Of The Provider | GARDNER |
| First Name Of The Provider | JON |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 380 CHASE ST |
| Street Address 2 Of The Provider | INTERNAL MEDICINE |
| City Of The Provider | WALLA WALLA |
| Zip Code Of The Provider | 99362 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 87 |
| Number Of Services | 5369 |
| Number Of Medicare Beneficiaries | 2100 |
| Total Submitted Charge Amount | 506383 |
| Total Medicare Allowed Amount | 223777.27 |
| Total Medicare Payment Amount | 170176.42 |
| Total Medicare Standardized Payment Amount | 170898.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 372 |
| Number Of Medicare Beneficiaries With Drug Services | 215 |
| Total Drug Submitted ChargeAmount | 29011 |
| Total Drug Medicare AllowedAmount | 17097.99 |
| Total Drug Medicare PaymentAmount | 16117.18 |
| Total Drug Medicare Standardized Payment Amount | 16117.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 4997 |
| Number Of Medicare Beneficiaries With Medical Services | 2100 |
| Total Medical Submitted Charge Amount | 477372 |
| Total Medical Medicare Allowed Amount | 206679.28 |
| Total Medical Medicare Payment Amount | 154059.24 |
| Total Medical Medicare Standardized Payment Amount | 154781.54 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 208 |
| Number Of Beneficiaries Age 65 to 74 | 761 |
| Number Of Beneficiaries Age 75 to 84 | 661 |
| Number Of Beneficiaries Age Greater 84 | 470 |
| Number Of Female Beneficiaries | 1128 |
| Number Of Male Beneficiaries | 972 |
| Number Of Non Hispanic White Beneficiaries | 1969 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 78 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1747 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 353 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.408 |