| National Provider Identifier [NPI]: | 1740264357 |
| Last Name Of The Provider | MEARES |
| First Name Of The Provider | AGESELAOS |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2301 HOUSE AVE |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | CHEYENNE |
| Zip Code Of The Provider | 820013176 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 2131 |
| Number Of Medicare Beneficiaries | 480 |
| Total Submitted Charge Amount | 744434.33 |
| Total Medicare Allowed Amount | 262625.39 |
| Total Medicare Payment Amount | 199562.92 |
| Total Medicare Standardized Payment Amount | 202942.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 18 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 691.23 |
| Total Drug Medicare AllowedAmount | 286.09 |
| Total Drug Medicare PaymentAmount | 279.82 |
| Total Drug Medicare Standardized Payment Amount | 279.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 2113 |
| Number Of Medicare Beneficiaries With Medical Services | 480 |
| Total Medical Submitted Charge Amount | 743743.1 |
| Total Medical Medicare Allowed Amount | 262339.3 |
| Total Medical Medicare Payment Amount | 199283.1 |
| Total Medical Medicare Standardized Payment Amount | 202662.91 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 111 |
| Number Of Beneficiaries Age 65 to 74 | 163 |
| Number Of Beneficiaries Age 75 to 84 | 146 |
| Number Of Beneficiaries Age Greater 84 | 60 |
| Number Of Female Beneficiaries | 234 |
| Number Of Male Beneficiaries | 246 |
| Number Of Non Hispanic White Beneficiaries | 400 |
| Number Of Black or African American Beneficiaries | 19 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 49 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 398 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 82 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 2.6003 |