| National Provider Identifier [NPI]: | 1982689733 |
| Last Name Of The Provider | BOUWKAMP |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2111 12 MILE RD NW |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPARTA |
| Zip Code Of The Provider | 493459754 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 446 |
| Number Of Medicare Beneficiaries | 212 |
| Total Submitted Charge Amount | 49304 |
| Total Medicare Allowed Amount | 23390.7 |
| Total Medicare Payment Amount | 16137.02 |
| Total Medicare Standardized Payment Amount | 20281.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 53 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 873 |
| Total Drug Medicare AllowedAmount | 566.1 |
| Total Drug Medicare PaymentAmount | 527.94 |
| Total Drug Medicare Standardized Payment Amount | 527.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 393 |
| Number Of Medicare Beneficiaries With Medical Services | 212 |
| Total Medical Submitted Charge Amount | 48431 |
| Total Medical Medicare Allowed Amount | 22824.6 |
| Total Medical Medicare Payment Amount | 15609.08 |
| Total Medical Medicare Standardized Payment Amount | 19753.08 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 56 |
| Number Of Beneficiaries Age 75 to 84 | 68 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 105 |
| Number Of Male Beneficiaries | 107 |
| 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 | 162 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 50 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2961 |