| National Provider Identifier [NPI]: | 1730197211 |
| Last Name Of The Provider | BULLER |
| First Name Of The Provider | KEITH |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1701 OAK PARK BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKE CHARLES |
| Zip Code Of The Provider | 706018911 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 111 |
| Number Of Services | 5448 |
| Number Of Medicare Beneficiaries | 674 |
| Total Submitted Charge Amount | 262550.5 |
| Total Medicare Allowed Amount | 114003.94 |
| Total Medicare Payment Amount | 78985.27 |
| Total Medicare Standardized Payment Amount | 100437.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 33 |
| Number Of Drug Services | 3421 |
| Number Of Medicare Beneficiaries With Drug Services | 403 |
| Total Drug Submitted ChargeAmount | 17587.5 |
| Total Drug Medicare AllowedAmount | 1605.57 |
| Total Drug Medicare PaymentAmount | 1140.17 |
| Total Drug Medicare Standardized Payment Amount | 1140.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 78 |
| Number Of Medical Services | 2027 |
| Number Of Medicare Beneficiaries With Medical Services | 674 |
| Total Medical Submitted Charge Amount | 244963 |
| Total Medical Medicare Allowed Amount | 112398.37 |
| Total Medical Medicare Payment Amount | 77845.1 |
| Total Medical Medicare Standardized Payment Amount | 99297.35 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 122 |
| Number Of Beneficiaries Age 65 to 74 | 326 |
| Number Of Beneficiaries Age 75 to 84 | 176 |
| Number Of Beneficiaries Age Greater 84 | 50 |
| Number Of Female Beneficiaries | 409 |
| Number Of Male Beneficiaries | 265 |
| Number Of Non Hispanic White Beneficiaries | 638 |
| Number Of Black or African American Beneficiaries | 20 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 586 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 88 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0122 |