| National Provider Identifier [NPI]: | 1487746459 |
| Last Name Of The Provider | GRACE |
| First Name Of The Provider | BRIAN |
| 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 | 840 S RANCHO DR |
| Street Address 2 Of The Provider | #4410 |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891063837 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 359 |
| Number Of Medicare Beneficiaries | 147 |
| Total Submitted Charge Amount | 93303 |
| Total Medicare Allowed Amount | 24575.84 |
| Total Medicare Payment Amount | 17666.41 |
| Total Medicare Standardized Payment Amount | 19643.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 32 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 3120 |
| Total Drug Medicare AllowedAmount | 1969.7 |
| Total Drug Medicare PaymentAmount | 1313.77 |
| Total Drug Medicare Standardized Payment Amount | 1313.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 327 |
| Number Of Medicare Beneficiaries With Medical Services | 147 |
| Total Medical Submitted Charge Amount | 90183 |
| Total Medical Medicare Allowed Amount | 22606.14 |
| Total Medical Medicare Payment Amount | 16352.64 |
| Total Medical Medicare Standardized Payment Amount | 18329.44 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 88 |
| Number Of Beneficiaries Age 75 to 84 | 30 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 103 |
| Number Of Male Beneficiaries | 44 |
| Number Of Non Hispanic White Beneficiaries | 121 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 126 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2838 |