| National Provider Identifier [NPI]: | 1548496714 |
| Last Name Of The Provider | BRODDLE |
| First Name Of The Provider | BRYAN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | CRNA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2610 N. WOODLAWN |
| Street Address 2 Of The Provider | |
| City Of The Provider | WICHITA |
| Zip Code Of The Provider | 672202729 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | CRNA |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 351 |
| Number Of Medicare Beneficiaries | 320 |
| Total Submitted Charge Amount | 228622 |
| Total Medicare Allowed Amount | 56222.64 |
| Total Medicare Payment Amount | 43702.07 |
| Total Medicare Standardized Payment Amount | 45108.9 |
| 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 | 49 |
| Number Of Medical Services | 351 |
| Number Of Medicare Beneficiaries With Medical Services | 320 |
| Total Medical Submitted Charge Amount | 228622 |
| Total Medical Medicare Allowed Amount | 56222.64 |
| Total Medical Medicare Payment Amount | 43702.07 |
| Total Medical Medicare Standardized Payment Amount | 45108.9 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 58 |
| Number Of Beneficiaries Age 65 to 74 | 109 |
| Number Of Beneficiaries Age 75 to 84 | 112 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 178 |
| Number Of Male Beneficiaries | 142 |
| Number Of Non Hispanic White Beneficiaries | 277 |
| Number Of Black or African American Beneficiaries | 26 |
| 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 | 251 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | 30 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 67 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.6275 |