| National Provider Identifier [NPI]: | 1659352649 |
| Last Name Of The Provider | SAMUELSON |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 925 IRONWOOD DR |
| Street Address 2 Of The Provider | SUITE 25108 |
| City Of The Provider | MINDEN |
| Zip Code Of The Provider | 894235178 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 660 |
| Number Of Medicare Beneficiaries | 150 |
| Total Submitted Charge Amount | 71866.46 |
| Total Medicare Allowed Amount | 35470.14 |
| Total Medicare Payment Amount | 24313.54 |
| Total Medicare Standardized Payment Amount | 28205.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 91 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 1135 |
| Total Drug Medicare AllowedAmount | 573 |
| Total Drug Medicare PaymentAmount | 500.95 |
| Total Drug Medicare Standardized Payment Amount | 500.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 569 |
| Number Of Medicare Beneficiaries With Medical Services | 150 |
| Total Medical Submitted Charge Amount | 70731.46 |
| Total Medical Medicare Allowed Amount | 34897.14 |
| Total Medical Medicare Payment Amount | 23812.59 |
| Total Medical Medicare Standardized Payment Amount | 27704.65 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 88 |
| Number Of Beneficiaries Age 75 to 84 | 31 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 69 |
| Number Of Male Beneficiaries | 81 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 135 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 29 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9373 |