| National Provider Identifier [NPI]: | 1174512115 |
| Last Name Of The Provider | GUILLETTE |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1010 THREE SPRINGS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DURANGO |
| Zip Code Of The Provider | 813018296 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 1129 |
| Number Of Medicare Beneficiaries | 646 |
| Total Submitted Charge Amount | 179549.34 |
| Total Medicare Allowed Amount | 74181.64 |
| Total Medicare Payment Amount | 51875.33 |
| Total Medicare Standardized Payment Amount | 63514.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 176 |
| Number Of Medicare Beneficiaries With Drug Services | 81 |
| Total Drug Submitted ChargeAmount | 1554.8 |
| Total Drug Medicare AllowedAmount | 566.2 |
| Total Drug Medicare PaymentAmount | 540.12 |
| Total Drug Medicare Standardized Payment Amount | 540.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 953 |
| Number Of Medicare Beneficiaries With Medical Services | 645 |
| Total Medical Submitted Charge Amount | 177994.54 |
| Total Medical Medicare Allowed Amount | 73615.44 |
| Total Medical Medicare Payment Amount | 51335.21 |
| Total Medical Medicare Standardized Payment Amount | 62974.71 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 335 |
| Number Of Beneficiaries Age 75 to 84 | 178 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 395 |
| Number Of Male Beneficiaries | 251 |
| Number Of Non Hispanic White Beneficiaries | 577 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | 20 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 584 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8948 |