| National Provider Identifier [NPI]: | 1568577260 |
| Last Name Of The Provider | BEAVER |
| First Name Of The Provider | JACQUELINE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 505 N DIERS AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAND ISLAND |
| Zip Code Of The Provider | 688034983 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 5455 |
| Number Of Medicare Beneficiaries | 753 |
| Total Submitted Charge Amount | 419183.2 |
| Total Medicare Allowed Amount | 186979.44 |
| Total Medicare Payment Amount | 129022.1 |
| Total Medicare Standardized Payment Amount | 162398.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 64 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 10587.2 |
| Total Drug Medicare AllowedAmount | 9670.88 |
| Total Drug Medicare PaymentAmount | 7121.54 |
| Total Drug Medicare Standardized Payment Amount | 7121.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 5391 |
| Number Of Medicare Beneficiaries With Medical Services | 753 |
| Total Medical Submitted Charge Amount | 408596 |
| Total Medical Medicare Allowed Amount | 177308.56 |
| Total Medical Medicare Payment Amount | 121900.56 |
| Total Medical Medicare Standardized Payment Amount | 155277.16 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 60 |
| Number Of Beneficiaries Age 65 to 74 | 321 |
| Number Of Beneficiaries Age 75 to 84 | 264 |
| Number Of Beneficiaries Age Greater 84 | 108 |
| Number Of Female Beneficiaries | 426 |
| Number Of Male Beneficiaries | 327 |
| Number Of Non Hispanic White Beneficiaries | 733 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 679 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 74 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9705 |