| National Provider Identifier [NPI]: | 1689007064 |
| Last Name Of The Provider | PELLETIER |
| First Name Of The Provider | DARREN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.S., PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 925 UNION ST |
| Street Address 2 Of The Provider | SUITE 3 |
| City Of The Provider | BANGOR |
| Zip Code Of The Provider | 044013051 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 390 |
| Number Of Medicare Beneficiaries | 203 |
| Total Submitted Charge Amount | 113400 |
| Total Medicare Allowed Amount | 25486.65 |
| Total Medicare Payment Amount | 18969.58 |
| Total Medicare Standardized Payment Amount | 22519.35 |
| 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 | 28 |
| Number Of Medical Services | 390 |
| Number Of Medicare Beneficiaries With Medical Services | 203 |
| Total Medical Submitted Charge Amount | 113400 |
| Total Medical Medicare Allowed Amount | 25486.65 |
| Total Medical Medicare Payment Amount | 18969.58 |
| Total Medical Medicare Standardized Payment Amount | 22519.35 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 77 |
| Number Of Beneficiaries Age 75 to 84 | 59 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 103 |
| 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 | 118 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 85 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2812 |