| National Provider Identifier [NPI]: | 1487841151 |
| Last Name Of The Provider | FENTRESS |
| First Name Of The Provider | DUSTIN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 102 N MAGDALEN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN ANGELO |
| Zip Code Of The Provider | 769035400 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 130 |
| Number Of Services | 3585 |
| Number Of Medicare Beneficiaries | 624 |
| Total Submitted Charge Amount | 220308.85 |
| Total Medicare Allowed Amount | 150137.8 |
| Total Medicare Payment Amount | 113542.85 |
| Total Medicare Standardized Payment Amount | 131937.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 1699 |
| Number Of Medicare Beneficiaries With Drug Services | 279 |
| Total Drug Submitted ChargeAmount | 22443.62 |
| Total Drug Medicare AllowedAmount | 21616.38 |
| Total Drug Medicare PaymentAmount | 16702.47 |
| Total Drug Medicare Standardized Payment Amount | 16702.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 123 |
| Number Of Medical Services | 1886 |
| Number Of Medicare Beneficiaries With Medical Services | 617 |
| Total Medical Submitted Charge Amount | 197865.23 |
| Total Medical Medicare Allowed Amount | 128521.42 |
| Total Medical Medicare Payment Amount | 96840.38 |
| Total Medical Medicare Standardized Payment Amount | 115235.19 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 165 |
| Number Of Beneficiaries Age 65 to 74 | 233 |
| Number Of Beneficiaries Age 75 to 84 | 181 |
| Number Of Beneficiaries Age Greater 84 | 45 |
| Number Of Female Beneficiaries | 361 |
| Number Of Male Beneficiaries | 263 |
| Number Of Non Hispanic White Beneficiaries | 455 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 140 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 470 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 154 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 70 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2544 |