| National Provider Identifier [NPI]: | 1497846091 |
| Last Name Of The Provider | WILLIS |
| First Name Of The Provider | CHARLA |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2315 8TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LEWISTON |
| Zip Code Of The Provider | 835017301 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 135 |
| Number Of Services | 5620 |
| Number Of Medicare Beneficiaries | 553 |
| Total Submitted Charge Amount | 327480.22 |
| Total Medicare Allowed Amount | 143132.07 |
| Total Medicare Payment Amount | 101110.39 |
| Total Medicare Standardized Payment Amount | 110708.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 763 |
| Number Of Medicare Beneficiaries With Drug Services | 49 |
| Total Drug Submitted ChargeAmount | 2921.54 |
| Total Drug Medicare AllowedAmount | 2057.8 |
| Total Drug Medicare PaymentAmount | 1974.35 |
| Total Drug Medicare Standardized Payment Amount | 1974.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 127 |
| Number Of Medical Services | 4857 |
| Number Of Medicare Beneficiaries With Medical Services | 553 |
| Total Medical Submitted Charge Amount | 324558.68 |
| Total Medical Medicare Allowed Amount | 141074.27 |
| Total Medical Medicare Payment Amount | 99136.04 |
| Total Medical Medicare Standardized Payment Amount | 108733.72 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 69 |
| Number Of Beneficiaries Age 65 to 74 | 235 |
| Number Of Beneficiaries Age 75 to 84 | 168 |
| Number Of Beneficiaries Age Greater 84 | 81 |
| Number Of Female Beneficiaries | 357 |
| Number Of Male Beneficiaries | 196 |
| Number Of Non Hispanic White Beneficiaries | 539 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 462 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 91 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1044 |