| National Provider Identifier [NPI]: | 1982612149 |
| Last Name Of The Provider | BOLLINGER |
| First Name Of The Provider | HIRAM |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MPAS, PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1800 7TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WICHITA FALLS |
| Zip Code Of The Provider | 763014204 |
| 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 | 11 |
| Number Of Services | 130 |
| Number Of Medicare Beneficiaries | 77 |
| Total Submitted Charge Amount | 15803.18 |
| Total Medicare Allowed Amount | 8588.87 |
| Total Medicare Payment Amount | 6592.09 |
| Total Medicare Standardized Payment Amount | 8130.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 25 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 755 |
| Total Drug Medicare AllowedAmount | 46.48 |
| Total Drug Medicare PaymentAmount | 36.48 |
| Total Drug Medicare Standardized Payment Amount | 36.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 8 |
| Number Of Medical Services | 105 |
| Number Of Medicare Beneficiaries With Medical Services | 77 |
| Total Medical Submitted Charge Amount | 15048.18 |
| Total Medical Medicare Allowed Amount | 8542.39 |
| Total Medical Medicare Payment Amount | 6555.61 |
| Total Medical Medicare Standardized Payment Amount | 8094.44 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 32 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 46 |
| Number Of Male Beneficiaries | 31 |
| Number Of Non Hispanic White Beneficiaries | 49 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 44 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0905 |