| National Provider Identifier [NPI]: | 1619157427 |
| Last Name Of The Provider | BRANTLY |
| First Name Of The Provider | ELISA |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 120 E BEAUREGARD AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN ANGELO |
| Zip Code Of The Provider | 769035919 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 133 |
| Number Of Services | 3747 |
| Number Of Medicare Beneficiaries | 444 |
| Total Submitted Charge Amount | 170857.67 |
| Total Medicare Allowed Amount | 149386.44 |
| Total Medicare Payment Amount | 115075.82 |
| Total Medicare Standardized Payment Amount | 120777.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 2052 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 11202.09 |
| Total Drug Medicare AllowedAmount | 10931.68 |
| Total Drug Medicare PaymentAmount | 8577.38 |
| Total Drug Medicare Standardized Payment Amount | 8577.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 126 |
| Number Of Medical Services | 1695 |
| Number Of Medicare Beneficiaries With Medical Services | 443 |
| Total Medical Submitted Charge Amount | 159655.58 |
| Total Medical Medicare Allowed Amount | 138454.76 |
| Total Medical Medicare Payment Amount | 106498.44 |
| Total Medical Medicare Standardized Payment Amount | 112199.87 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 187 |
| Number Of Beneficiaries Age 75 to 84 | 147 |
| Number Of Beneficiaries Age Greater 84 | 66 |
| Number Of Female Beneficiaries | 233 |
| Number Of Male Beneficiaries | 211 |
| Number Of Non Hispanic White Beneficiaries | 364 |
| 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 | 369 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 75 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2494 |