| National Provider Identifier [NPI]: | 1457350142 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | C.R.N.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6140 S MEMORIAL DR |
| Street Address 2 Of The Provider | SUITE 104 |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741331933 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | CRNA |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 6 |
| Number Of Services | 2106 |
| Number Of Medicare Beneficiaries | 1298 |
| Total Submitted Charge Amount | 1075974.54 |
| Total Medicare Allowed Amount | 231291.71 |
| Total Medicare Payment Amount | 179699.11 |
| Total Medicare Standardized Payment Amount | 189212.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 6 |
| Number Of Medical Services | 2106 |
| Number Of Medicare Beneficiaries With Medical Services | 1298 |
| Total Medical Submitted Charge Amount | 1075974.54 |
| Total Medical Medicare Allowed Amount | 231291.71 |
| Total Medical Medicare Payment Amount | 179699.11 |
| Total Medical Medicare Standardized Payment Amount | 189212.51 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 101 |
| Number Of Beneficiaries Age 65 to 74 | 719 |
| Number Of Beneficiaries Age 75 to 84 | 404 |
| Number Of Beneficiaries Age Greater 84 | 74 |
| Number Of Female Beneficiaries | 745 |
| Number Of Male Beneficiaries | 553 |
| Number Of Non Hispanic White Beneficiaries | 935 |
| Number Of Black or African American Beneficiaries | 35 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 308 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1049 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 249 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0825 |