| National Provider Identifier [NPI]: | 1578833026 |
| Last Name Of The Provider | HALL |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2811 E 15TH ST |
| Street Address 2 Of The Provider | SUITE 102 |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741045245 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 1162 |
| Number Of Medicare Beneficiaries | 392 |
| Total Submitted Charge Amount | 106249.78 |
| Total Medicare Allowed Amount | 48180.86 |
| Total Medicare Payment Amount | 36780.08 |
| Total Medicare Standardized Payment Amount | 46187.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 395 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 8611.72 |
| Total Drug Medicare AllowedAmount | 5001.97 |
| Total Drug Medicare PaymentAmount | 3920.54 |
| Total Drug Medicare Standardized Payment Amount | 3920.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 767 |
| Number Of Medicare Beneficiaries With Medical Services | 392 |
| Total Medical Submitted Charge Amount | 97638.06 |
| Total Medical Medicare Allowed Amount | 43178.89 |
| Total Medical Medicare Payment Amount | 32859.54 |
| Total Medical Medicare Standardized Payment Amount | 42266.48 |
| Average Age Of Beneficiaries | 60 |
| Number Of Beneficiaries Age Less65 | 248 |
| Number Of Beneficiaries Age 65 to 74 | 96 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 275 |
| Number Of Male Beneficiaries | 117 |
| Number Of Non Hispanic White Beneficiaries | 295 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 55 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 206 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 186 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 48 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.4039 |