| National Provider Identifier [NPI]: | 1689627069 |
| Last Name Of The Provider | MCDERMOTT |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3101 E STATE ST |
| Street Address 2 Of The Provider | SUITE 2120 |
| City Of The Provider | EAGLE |
| Zip Code Of The Provider | 83616 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 744 |
| Number Of Medicare Beneficiaries | 492 |
| Total Submitted Charge Amount | 43916.1 |
| Total Medicare Allowed Amount | 32797.24 |
| Total Medicare Payment Amount | 22416.04 |
| Total Medicare Standardized Payment Amount | 29152.32 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 175 |
| Number Of Beneficiaries Age 75 to 84 | 159 |
| Number Of Beneficiaries Age Greater 84 | 105 |
| Number Of Female Beneficiaries | 296 |
| Number Of Male Beneficiaries | 196 |
| Number Of Non Hispanic White Beneficiaries | 464 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 431 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4055 |