| National Provider Identifier [NPI]: | 1891097234 |
| Last Name Of The Provider | REYNOLDS |
| First Name Of The Provider | MERRICK |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 526 SHOUP AVE W |
| Street Address 2 Of The Provider | SUITE E |
| City Of The Provider | TWIN FALLS |
| Zip Code Of The Provider | 833015050 |
| 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 | 19 |
| Number Of Services | 557 |
| Number Of Medicare Beneficiaries | 83 |
| Total Submitted Charge Amount | 28163.73 |
| Total Medicare Allowed Amount | 14624.35 |
| Total Medicare Payment Amount | 9761.72 |
| Total Medicare Standardized Payment Amount | 12926.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 319 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 480.5 |
| Total Drug Medicare AllowedAmount | 316.47 |
| Total Drug Medicare PaymentAmount | 288.33 |
| Total Drug Medicare Standardized Payment Amount | 288.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 11 |
| Number Of Medical Services | 238 |
| Number Of Medicare Beneficiaries With Medical Services | 83 |
| Total Medical Submitted Charge Amount | 27683.23 |
| Total Medical Medicare Allowed Amount | 14307.88 |
| Total Medical Medicare Payment Amount | 9473.39 |
| Total Medical Medicare Standardized Payment Amount | 12637.73 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 29 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 41 |
| Number Of Male Beneficiaries | 42 |
| 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 | 51 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| 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 | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 14 |
| Percent Of With Hyperlipidemia | 25 |
| Percent Of With Hypertension | 36 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0389 |