| National Provider Identifier [NPI]: | 1790753267 |
| Last Name Of The Provider | BULL |
| First Name Of The Provider | JILL |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2900 BROADWAY ST |
| Street Address 2 Of The Provider | CVS/MINUTE CLINIC |
| City Of The Provider | PEARLAND |
| Zip Code Of The Provider | 775814507 |
| 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 | 13 |
| Number Of Services | 42 |
| Number Of Medicare Beneficiaries | 23 |
| Total Submitted Charge Amount | 1682.88 |
| Total Medicare Allowed Amount | 1507.9 |
| Total Medicare Payment Amount | 1083.57 |
| Total Medicare Standardized Payment Amount | 1311.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 13 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 332.88 |
| Total Drug Medicare AllowedAmount | 332.88 |
| Total Drug Medicare PaymentAmount | 326.02 |
| Total Drug Medicare Standardized Payment Amount | 326.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 29 |
| Number Of Medicare Beneficiaries With Medical Services | 23 |
| Total Medical Submitted Charge Amount | 1350 |
| Total Medical Medicare Allowed Amount | 1175.02 |
| Total Medical Medicare Payment Amount | 757.55 |
| Total Medical Medicare Standardized Payment Amount | 985.27 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| 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 | 23 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 0 |
| 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 | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 0 |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8445 |