| National Provider Identifier [NPI]: | 1417903709 |
| Last Name Of The Provider | DONALDSON |
| First Name Of The Provider | TERRY |
| 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 | 1204 HILLTOP DR. |
| Street Address 2 Of The Provider | SUITE 108 |
| City Of The Provider | ROCK SPRINGS |
| Zip Code Of The Provider | 82901 |
| 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 | 91 |
| Number Of Services | 7467 |
| Number Of Medicare Beneficiaries | 643 |
| Total Submitted Charge Amount | 574955.26 |
| Total Medicare Allowed Amount | 236205.51 |
| Total Medicare Payment Amount | 172876.14 |
| Total Medicare Standardized Payment Amount | 173238.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 1029 |
| Number Of Medicare Beneficiaries With Drug Services | 197 |
| Total Drug Submitted ChargeAmount | 19927.26 |
| Total Drug Medicare AllowedAmount | 12964.74 |
| Total Drug Medicare PaymentAmount | 10737.88 |
| Total Drug Medicare Standardized Payment Amount | 10737.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 81 |
| Number Of Medical Services | 6438 |
| Number Of Medicare Beneficiaries With Medical Services | 643 |
| Total Medical Submitted Charge Amount | 555028 |
| Total Medical Medicare Allowed Amount | 223240.77 |
| Total Medical Medicare Payment Amount | 162138.26 |
| Total Medical Medicare Standardized Payment Amount | 162500.45 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 79 |
| Number Of Beneficiaries Age 65 to 74 | 286 |
| Number Of Beneficiaries Age 75 to 84 | 204 |
| Number Of Beneficiaries Age Greater 84 | 74 |
| Number Of Female Beneficiaries | 340 |
| Number Of Male Beneficiaries | 303 |
| Number Of Non Hispanic White Beneficiaries | 589 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 564 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 79 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 25 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.03 |