| National Provider Identifier [NPI]: | 1457352478 |
| Last Name Of The Provider | ALLAIS |
| First Name Of The Provider | JEAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 255 N. 30TH ST |
| Street Address 2 Of The Provider | ADULT & GERIATRIC MEDICAL SPECIALTIES |
| City Of The Provider | LARAMIE |
| Zip Code Of The Provider | 82072 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 1313 |
| Number Of Medicare Beneficiaries | 281 |
| Total Submitted Charge Amount | 136799 |
| Total Medicare Allowed Amount | 90300.27 |
| Total Medicare Payment Amount | 69652.39 |
| Total Medicare Standardized Payment Amount | 70056.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 45 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 1093 |
| Total Drug Medicare AllowedAmount | 837.75 |
| Total Drug Medicare PaymentAmount | 818.11 |
| Total Drug Medicare Standardized Payment Amount | 818.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 1268 |
| Number Of Medicare Beneficiaries With Medical Services | 281 |
| Total Medical Submitted Charge Amount | 135706 |
| Total Medical Medicare Allowed Amount | 89462.52 |
| Total Medical Medicare Payment Amount | 68834.28 |
| Total Medical Medicare Standardized Payment Amount | 69238.56 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 131 |
| Number Of Beneficiaries Age 75 to 84 | 79 |
| Number Of Beneficiaries Age Greater 84 | 56 |
| Number Of Female Beneficiaries | 177 |
| Number Of Male Beneficiaries | 104 |
| Number Of Non Hispanic White Beneficiaries | 257 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 267 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8335 |