| National Provider Identifier [NPI]: | 1992743330 |
| Last Name Of The Provider | BOSCAMP |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 403 W MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BELGRADE |
| Zip Code Of The Provider | 597143847 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 254 |
| Number Of Medicare Beneficiaries | 145 |
| Total Submitted Charge Amount | 20677.43 |
| Total Medicare Allowed Amount | 10794.04 |
| Total Medicare Payment Amount | 6880.52 |
| Total Medicare Standardized Payment Amount | 8449.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 33 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 382 |
| Total Drug Medicare AllowedAmount | 164.23 |
| Total Drug Medicare PaymentAmount | 151.77 |
| Total Drug Medicare Standardized Payment Amount | 151.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 221 |
| Number Of Medicare Beneficiaries With Medical Services | 145 |
| Total Medical Submitted Charge Amount | 20295.43 |
| Total Medical Medicare Allowed Amount | 10629.81 |
| Total Medical Medicare Payment Amount | 6728.75 |
| Total Medical Medicare Standardized Payment Amount | 8297.91 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 59 |
| Number Of Beneficiaries Age 75 to 84 | 47 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 88 |
| Number Of Male Beneficiaries | 57 |
| 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 | 122 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 14 |
| Percent Of With Hyperlipidemia | 24 |
| Percent Of With Hypertension | 29 |
| Percent Of With Ischemic Heart Disease | 13 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7801 |