| National Provider Identifier [NPI]: | 1811962988 |
| Last Name Of The Provider | BOUCHER |
| First Name Of The Provider | WENDY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1001 NOBLE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | FAIRBANKS |
| Zip Code Of The Provider | 997014922 |
| State Code Of The Provider | AK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 345 |
| Number Of Medicare Beneficiaries | 63 |
| Total Submitted Charge Amount | 233984.04 |
| Total Medicare Allowed Amount | 42522.82 |
| Total Medicare Payment Amount | 32699.42 |
| Total Medicare Standardized Payment Amount | 26558.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 128 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 7518.64 |
| Total Drug Medicare AllowedAmount | 1400.86 |
| Total Drug Medicare PaymentAmount | 1098.21 |
| Total Drug Medicare Standardized Payment Amount | 1098.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 217 |
| Number Of Medicare Beneficiaries With Medical Services | 63 |
| Total Medical Submitted Charge Amount | 226465.4 |
| Total Medical Medicare Allowed Amount | 41121.96 |
| Total Medical Medicare Payment Amount | 31601.21 |
| Total Medical Medicare Standardized Payment Amount | 25460.75 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 23 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 39 |
| Number Of Male Beneficiaries | 24 |
| 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 | 44 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| 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 | 17 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0117 |