| National Provider Identifier [NPI]: | 1194745497 |
| Last Name Of The Provider | BOLTON |
| First Name Of The Provider | KIRSTEN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2781 HIGHWAY 145 |
| Street Address 2 Of The Provider | |
| City Of The Provider | SALTILLO |
| Zip Code Of The Provider | 388669783 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 2045 |
| Number Of Medicare Beneficiaries | 337 |
| Total Submitted Charge Amount | 112595 |
| Total Medicare Allowed Amount | 64533.85 |
| Total Medicare Payment Amount | 42319.43 |
| Total Medicare Standardized Payment Amount | 46500.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 435 |
| Number Of Medicare Beneficiaries With Drug Services | 110 |
| Total Drug Submitted ChargeAmount | 10412 |
| Total Drug Medicare AllowedAmount | 2099.2 |
| Total Drug Medicare PaymentAmount | 1659.94 |
| Total Drug Medicare Standardized Payment Amount | 1659.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 1610 |
| Number Of Medicare Beneficiaries With Medical Services | 337 |
| Total Medical Submitted Charge Amount | 102183 |
| Total Medical Medicare Allowed Amount | 62434.65 |
| Total Medical Medicare Payment Amount | 40659.49 |
| Total Medical Medicare Standardized Payment Amount | 44840.9 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 176 |
| Number Of Beneficiaries Age 65 to 74 | 104 |
| Number Of Beneficiaries Age 75 to 84 | 43 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 221 |
| Number Of Male Beneficiaries | 116 |
| Number Of Non Hispanic White Beneficiaries | 323 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 143 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 194 |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 28 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9716 |