| National Provider Identifier [NPI]: | 1619284239 |
| Last Name Of The Provider | HALL |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 121 S CRESCENT DR |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | PUEBLO WEST |
| Zip Code Of The Provider | 810075433 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 2162 |
| Number Of Medicare Beneficiaries | 276 |
| Total Submitted Charge Amount | 147648.73 |
| Total Medicare Allowed Amount | 51935.19 |
| Total Medicare Payment Amount | 36406.81 |
| Total Medicare Standardized Payment Amount | 43550.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 1113 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 1825.93 |
| Total Drug Medicare AllowedAmount | 893.64 |
| Total Drug Medicare PaymentAmount | 811.83 |
| Total Drug Medicare Standardized Payment Amount | 811.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 1049 |
| Number Of Medicare Beneficiaries With Medical Services | 276 |
| Total Medical Submitted Charge Amount | 145822.8 |
| Total Medical Medicare Allowed Amount | 51041.55 |
| Total Medical Medicare Payment Amount | 35594.98 |
| Total Medical Medicare Standardized Payment Amount | 42738.5 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 72 |
| Number Of Beneficiaries Age 65 to 74 | 121 |
| Number Of Beneficiaries Age 75 to 84 | 70 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 132 |
| Number Of Male Beneficiaries | 144 |
| Number Of Non Hispanic White Beneficiaries | 237 |
| 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 | 207 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9652 |