| National Provider Identifier [NPI]: | 1427312438 |
| Last Name Of The Provider | DOLL |
| First Name Of The Provider | JESSE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2360 MULLAN RD |
| Street Address 2 Of The Provider | STE C |
| City Of The Provider | MISSOULA |
| Zip Code Of The Provider | 598081811 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 368 |
| Number Of Medicare Beneficiaries | 236 |
| Total Submitted Charge Amount | 154418.65 |
| Total Medicare Allowed Amount | 46635.56 |
| Total Medicare Payment Amount | 36301.77 |
| Total Medicare Standardized Payment Amount | 37411.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 510 |
| Total Drug Medicare AllowedAmount | 109.35 |
| Total Drug Medicare PaymentAmount | 79.84 |
| Total Drug Medicare Standardized Payment Amount | 79.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 334 |
| Number Of Medicare Beneficiaries With Medical Services | 236 |
| Total Medical Submitted Charge Amount | 153908.65 |
| Total Medical Medicare Allowed Amount | 46526.21 |
| Total Medical Medicare Payment Amount | 36221.93 |
| Total Medical Medicare Standardized Payment Amount | 37331.42 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 145 |
| Number Of Beneficiaries Age 75 to 84 | 57 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 135 |
| Number Of Male Beneficiaries | 101 |
| Number Of Non Hispanic White Beneficiaries | 224 |
| 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 | 219 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9114 |