| National Provider Identifier [NPI]: | 1740515287 |
| Last Name Of The Provider | LEVITCH |
| First Name Of The Provider | RACHEL |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | PHYSICIAN ASSISTANT |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 300 W MYRTLE ST |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | BOISE |
| Zip Code Of The Provider | 837027690 |
| 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 | 40 |
| Number Of Services | 361 |
| Number Of Medicare Beneficiaries | 139 |
| Total Submitted Charge Amount | 26524.81 |
| Total Medicare Allowed Amount | 12790.35 |
| Total Medicare Payment Amount | 8488.93 |
| Total Medicare Standardized Payment Amount | 11037.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 26 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 484 |
| Total Drug Medicare AllowedAmount | 450.83 |
| Total Drug Medicare PaymentAmount | 438.16 |
| Total Drug Medicare Standardized Payment Amount | 438.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 335 |
| Number Of Medicare Beneficiaries With Medical Services | 139 |
| Total Medical Submitted Charge Amount | 26040.81 |
| Total Medical Medicare Allowed Amount | 12339.52 |
| Total Medical Medicare Payment Amount | 8050.77 |
| Total Medical Medicare Standardized Payment Amount | 10599.12 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 58 |
| Number Of Beneficiaries Age 65 to 74 | 47 |
| Number Of Beneficiaries Age 75 to 84 | 22 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 85 |
| Number Of Male Beneficiaries | 54 |
| Number Of Non Hispanic White Beneficiaries | 127 |
| 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 | 85 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| 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 | |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 13 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8289 |