| National Provider Identifier [NPI]: | 1215933940 |
| Last Name Of The Provider | POWELL |
| First Name Of The Provider | GAVIN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 318 2ND ST S |
| Street Address 2 Of The Provider | |
| City Of The Provider | NAMPA |
| Zip Code Of The Provider | 836513765 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 93 |
| Number Of Services | 5124 |
| Number Of Medicare Beneficiaries | 653 |
| Total Submitted Charge Amount | 518261.11 |
| Total Medicare Allowed Amount | 289411.9 |
| Total Medicare Payment Amount | 207066.12 |
| Total Medicare Standardized Payment Amount | 224479.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 168 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 1377.54 |
| Total Drug Medicare AllowedAmount | 1041.3 |
| Total Drug Medicare PaymentAmount | 787.9 |
| Total Drug Medicare Standardized Payment Amount | 787.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 91 |
| Number Of Medical Services | 4956 |
| Number Of Medicare Beneficiaries With Medical Services | 653 |
| Total Medical Submitted Charge Amount | 516883.57 |
| Total Medical Medicare Allowed Amount | 288370.6 |
| Total Medical Medicare Payment Amount | 206278.22 |
| Total Medical Medicare Standardized Payment Amount | 223691.98 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 270 |
| Number Of Beneficiaries Age 75 to 84 | 242 |
| Number Of Beneficiaries Age Greater 84 | 127 |
| Number Of Female Beneficiaries | 314 |
| Number Of Male Beneficiaries | 339 |
| Number Of Non Hispanic White Beneficiaries | 638 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 620 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9734 |