| National Provider Identifier [NPI]: | 1083770192 |
| Last Name Of The Provider | OBRAY |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | ATC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | IDAHO STATE UNIVERSITY DEPT OF INTERCOLLEGIATE ATHLETIC |
| Street Address 2 Of The Provider | CAMPUS BOX 8173 |
| City Of The Provider | POCATELLO |
| Zip Code Of The Provider | 832090001 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 101 |
| Number Of Services | 645 |
| Number Of Medicare Beneficiaries | 204 |
| Total Submitted Charge Amount | 232406.46 |
| Total Medicare Allowed Amount | 41889.47 |
| Total Medicare Payment Amount | 32634.95 |
| Total Medicare Standardized Payment Amount | 36370.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 167 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 3616.96 |
| Total Drug Medicare AllowedAmount | 2574.99 |
| Total Drug Medicare PaymentAmount | 2018.65 |
| Total Drug Medicare Standardized Payment Amount | 2018.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 97 |
| Number Of Medical Services | 478 |
| Number Of Medicare Beneficiaries With Medical Services | 204 |
| Total Medical Submitted Charge Amount | 228789.5 |
| Total Medical Medicare Allowed Amount | 39314.48 |
| Total Medical Medicare Payment Amount | 30616.3 |
| Total Medical Medicare Standardized Payment Amount | 34351.53 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 78 |
| Number Of Beneficiaries Age 75 to 84 | 55 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 115 |
| Number Of Male Beneficiaries | 89 |
| Number Of Non Hispanic White Beneficiaries | 193 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 163 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 68 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0832 |