| National Provider Identifier [NPI]: | 1902147176 |
| Last Name Of The Provider | ISIDOR |
| First Name Of The Provider | KETURA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 CHOCTAW WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | TALIHINA |
| Zip Code Of The Provider | 745712022 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 606 |
| Number Of Medicare Beneficiaries | 177 |
| Total Submitted Charge Amount | 46617 |
| Total Medicare Allowed Amount | 21530.36 |
| Total Medicare Payment Amount | 15614.5 |
| Total Medicare Standardized Payment Amount | 19895.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 116 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 905 |
| Total Drug Medicare AllowedAmount | 99.59 |
| Total Drug Medicare PaymentAmount | 92.04 |
| Total Drug Medicare Standardized Payment Amount | 92.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 490 |
| Number Of Medicare Beneficiaries With Medical Services | 177 |
| Total Medical Submitted Charge Amount | 45712 |
| Total Medical Medicare Allowed Amount | 21430.77 |
| Total Medical Medicare Payment Amount | 15522.46 |
| Total Medical Medicare Standardized Payment Amount | 19803.71 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 94 |
| Number Of Beneficiaries Age 75 to 84 | 39 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 77 |
| Number Of Non Hispanic White Beneficiaries | 112 |
| 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 | 145 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9775 |