| National Provider Identifier [NPI]: | 1396728416 |
| Last Name Of The Provider | GENTRY |
| First Name Of The Provider | CARLA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8181 CORNERSTONE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAYDEN |
| Zip Code Of The Provider | 83835 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 1542 |
| Number Of Medicare Beneficiaries | 153 |
| Total Submitted Charge Amount | 64391.67 |
| Total Medicare Allowed Amount | 52608.87 |
| Total Medicare Payment Amount | 38403.11 |
| Total Medicare Standardized Payment Amount | 50598.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 153 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 1236.11 |
| Total Drug Medicare AllowedAmount | 1205.61 |
| Total Drug Medicare PaymentAmount | 1091.15 |
| Total Drug Medicare Standardized Payment Amount | 1091.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 1389 |
| Number Of Medicare Beneficiaries With Medical Services | 153 |
| Total Medical Submitted Charge Amount | 63155.56 |
| Total Medical Medicare Allowed Amount | 51403.26 |
| Total Medical Medicare Payment Amount | 37311.96 |
| Total Medical Medicare Standardized Payment Amount | 49507.52 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 75 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 110 |
| Number Of Male Beneficiaries | 43 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 122 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| 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 | 12 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.9258 |