| National Provider Identifier [NPI]: | 1992772446 |
| Last Name Of The Provider | MCCLAIN |
| First Name Of The Provider | BOELDRIDGE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12361 W. BOLA DR |
| Street Address 2 Of The Provider | #105 |
| City Of The Provider | SURPRISE |
| Zip Code Of The Provider | 85378 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 835 |
| Number Of Medicare Beneficiaries | 243 |
| Total Submitted Charge Amount | 279064.5 |
| Total Medicare Allowed Amount | 61089.02 |
| Total Medicare Payment Amount | 46172.72 |
| Total Medicare Standardized Payment Amount | 46165.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 202 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 327 |
| Total Drug Medicare AllowedAmount | 46.32 |
| Total Drug Medicare PaymentAmount | 36.46 |
| Total Drug Medicare Standardized Payment Amount | 36.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 633 |
| Number Of Medicare Beneficiaries With Medical Services | 219 |
| Total Medical Submitted Charge Amount | 278737.5 |
| Total Medical Medicare Allowed Amount | 61042.7 |
| Total Medical Medicare Payment Amount | 46136.26 |
| Total Medical Medicare Standardized Payment Amount | 46128.92 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 111 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 128 |
| Number Of Male Beneficiaries | 115 |
| Number Of Non Hispanic White Beneficiaries | 207 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 204 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3012 |