| National Provider Identifier [NPI]: | 1992020432 |
| Last Name Of The Provider | MARSHALL |
| First Name Of The Provider | TRAVIS |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | D.P.M |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 111 S 5TH ST |
| Street Address 2 Of The Provider | SUITE #7 |
| City Of The Provider | DOUGLAS |
| Zip Code Of The Provider | 826332434 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 935 |
| Number Of Medicare Beneficiaries | 270 |
| Total Submitted Charge Amount | 110093 |
| Total Medicare Allowed Amount | 46994.38 |
| Total Medicare Payment Amount | 32961.04 |
| Total Medicare Standardized Payment Amount | 32554.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 163 |
| Number Of Medicare Beneficiaries With Drug Services | 45 |
| Total Drug Submitted ChargeAmount | 2119 |
| Total Drug Medicare AllowedAmount | 925.62 |
| Total Drug Medicare PaymentAmount | 689.58 |
| Total Drug Medicare Standardized Payment Amount | 689.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 772 |
| Number Of Medicare Beneficiaries With Medical Services | 270 |
| Total Medical Submitted Charge Amount | 107974 |
| Total Medical Medicare Allowed Amount | 46068.76 |
| Total Medical Medicare Payment Amount | 32271.46 |
| Total Medical Medicare Standardized Payment Amount | 31865.1 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 92 |
| Number Of Beneficiaries Age 75 to 84 | 84 |
| Number Of Beneficiaries Age Greater 84 | 49 |
| Number Of Female Beneficiaries | 160 |
| Number Of Male Beneficiaries | 110 |
| Number Of Non Hispanic White Beneficiaries | 258 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 211 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3007 |