| National Provider Identifier [NPI]: | 1811995525 |
| Last Name Of The Provider | ANTLES |
| First Name Of The Provider | LEE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 406 YAUGER WAY SW |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | OLYMPIA |
| Zip Code Of The Provider | 985028151 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 2217 |
| Number Of Medicare Beneficiaries | 327 |
| Total Submitted Charge Amount | 275758.7 |
| Total Medicare Allowed Amount | 169607.93 |
| Total Medicare Payment Amount | 117439.31 |
| Total Medicare Standardized Payment Amount | 120853.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 136 |
| Number Of Medicare Beneficiaries With Drug Services | 109 |
| Total Drug Submitted ChargeAmount | 3151.2 |
| Total Drug Medicare AllowedAmount | 2809.99 |
| Total Drug Medicare PaymentAmount | 2664.45 |
| Total Drug Medicare Standardized Payment Amount | 2664.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 2081 |
| Number Of Medicare Beneficiaries With Medical Services | 327 |
| Total Medical Submitted Charge Amount | 272607.5 |
| Total Medical Medicare Allowed Amount | 166797.94 |
| Total Medical Medicare Payment Amount | 114774.86 |
| Total Medical Medicare Standardized Payment Amount | 118188.87 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 139 |
| Number Of Beneficiaries Age 75 to 84 | 118 |
| Number Of Beneficiaries Age Greater 84 | 55 |
| Number Of Female Beneficiaries | 157 |
| Number Of Male Beneficiaries | 170 |
| Number Of Non Hispanic White Beneficiaries | 313 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0523 |