| National Provider Identifier [NPI]: | 1699833269 |
| Last Name Of The Provider | FOORD |
| First Name Of The Provider | DONNA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | P.A.-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1301 N DIVISION AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SANDPOINT |
| Zip Code Of The Provider | 838648268 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 609 |
| Number Of Medicare Beneficiaries | 68 |
| Total Submitted Charge Amount | 64985.01 |
| Total Medicare Allowed Amount | 31867.4 |
| Total Medicare Payment Amount | 22620.72 |
| Total Medicare Standardized Payment Amount | 29660.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 32 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 843 |
| Total Drug Medicare AllowedAmount | 559.48 |
| Total Drug Medicare PaymentAmount | 546.72 |
| Total Drug Medicare Standardized Payment Amount | 546.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 577 |
| Number Of Medicare Beneficiaries With Medical Services | 68 |
| Total Medical Submitted Charge Amount | 64142.01 |
| Total Medical Medicare Allowed Amount | 31307.92 |
| Total Medical Medicare Payment Amount | 22074 |
| Total Medical Medicare Standardized Payment Amount | 29113.4 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 27 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 42 |
| Number Of Male Beneficiaries | 26 |
| 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 | 40 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| 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 | 19 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 25 |
| Percent Of With Hypertension | 35 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7989 |