| National Provider Identifier [NPI]: | 1124039201 |
| Last Name Of The Provider | VANDEVENDER |
| First Name Of The Provider | GINA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 810 HOSPITAL DR |
| Street Address 2 Of The Provider | STE 115 |
| City Of The Provider | BEAUMONT |
| Zip Code Of The Provider | 777014600 |
| 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 | 58 |
| Number Of Services | 5970 |
| Number Of Medicare Beneficiaries | 291 |
| Total Submitted Charge Amount | 300975 |
| Total Medicare Allowed Amount | 97134.95 |
| Total Medicare Payment Amount | 77791.16 |
| Total Medicare Standardized Payment Amount | 87897.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 1517 |
| Number Of Medicare Beneficiaries With Drug Services | 155 |
| Total Drug Submitted ChargeAmount | 24354 |
| Total Drug Medicare AllowedAmount | 2760.64 |
| Total Drug Medicare PaymentAmount | 2313.87 |
| Total Drug Medicare Standardized Payment Amount | 2313.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 4453 |
| Number Of Medicare Beneficiaries With Medical Services | 291 |
| Total Medical Submitted Charge Amount | 276621 |
| Total Medical Medicare Allowed Amount | 94374.31 |
| Total Medical Medicare Payment Amount | 75477.29 |
| Total Medical Medicare Standardized Payment Amount | 85583.58 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 153 |
| Number Of Beneficiaries Age 75 to 84 | 73 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 217 |
| Number Of Male Beneficiaries | 74 |
| Number Of Non Hispanic White Beneficiaries | 255 |
| 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 | 274 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0752 |