| National Provider Identifier [NPI]: | 1780780791 |
| Last Name Of The Provider | KIMBALL |
| First Name Of The Provider | CASSANDRA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1477 NORTH 2000 WEST |
| Street Address 2 Of The Provider | WESTSIDE MEDICAL |
| City Of The Provider | CLINTON |
| Zip Code Of The Provider | 84015 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 423 |
| Number Of Medicare Beneficiaries | 55 |
| Total Submitted Charge Amount | 19526.9 |
| Total Medicare Allowed Amount | 13044.07 |
| Total Medicare Payment Amount | 9551.97 |
| Total Medicare Standardized Payment Amount | 11349.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 175 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 3078.3 |
| Total Drug Medicare AllowedAmount | 2065.49 |
| Total Drug Medicare PaymentAmount | 1675.44 |
| Total Drug Medicare Standardized Payment Amount | 1675.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 248 |
| Number Of Medicare Beneficiaries With Medical Services | 55 |
| Total Medical Submitted Charge Amount | 16448.6 |
| Total Medical Medicare Allowed Amount | 10978.58 |
| Total Medical Medicare Payment Amount | 7876.53 |
| Total Medical Medicare Standardized Payment Amount | 9673.78 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 35 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| 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 | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8277 |