| National Provider Identifier [NPI]: | 1578759536 |
| Last Name Of The Provider | JUSTIN |
| First Name Of The Provider | CHARLENE |
| Middle Initial Of The Provider | O |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2490 HOSPITAL DR |
| Street Address 2 Of The Provider | SUITE 102 |
| City Of The Provider | MOUNTAIN VIEW |
| Zip Code Of The Provider | 940404122 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 219 |
| Number Of Medicare Beneficiaries | 89 |
| Total Submitted Charge Amount | 66227.7 |
| Total Medicare Allowed Amount | 15648.13 |
| Total Medicare Payment Amount | 12233.18 |
| Total Medicare Standardized Payment Amount | 11533.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 68 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 11495 |
| Total Drug Medicare AllowedAmount | 3901.99 |
| Total Drug Medicare PaymentAmount | 3059.18 |
| Total Drug Medicare Standardized Payment Amount | 3059.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 151 |
| Number Of Medicare Beneficiaries With Medical Services | 89 |
| Total Medical Submitted Charge Amount | 54732.7 |
| Total Medical Medicare Allowed Amount | 11746.14 |
| Total Medical Medicare Payment Amount | 9174 |
| Total Medical Medicare Standardized Payment Amount | 8474.17 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 40 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 63 |
| Number Of Male Beneficiaries | 26 |
| Number Of Non Hispanic White Beneficiaries | 60 |
| 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 | 67 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1318 |