| National Provider Identifier [NPI]: | 1376689059 |
| Last Name Of The Provider | WELCH |
| First Name Of The Provider | TIANA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2200 NE NEFF RD |
| Street Address 2 Of The Provider | SUITE 302 |
| City Of The Provider | BEND |
| Zip Code Of The Provider | 977014283 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 1085.5 |
| Number Of Medicare Beneficiaries | 357 |
| Total Submitted Charge Amount | 152518.12 |
| Total Medicare Allowed Amount | 54641.97 |
| Total Medicare Payment Amount | 41304.34 |
| Total Medicare Standardized Payment Amount | 50013.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 311.5 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 9533.22 |
| Total Drug Medicare AllowedAmount | 7040.42 |
| Total Drug Medicare PaymentAmount | 5519.72 |
| Total Drug Medicare Standardized Payment Amount | 5519.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 774 |
| Number Of Medicare Beneficiaries With Medical Services | 357 |
| Total Medical Submitted Charge Amount | 142984.9 |
| Total Medical Medicare Allowed Amount | 47601.55 |
| Total Medical Medicare Payment Amount | 35784.62 |
| Total Medical Medicare Standardized Payment Amount | 44493.69 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 72 |
| Number Of Beneficiaries Age 65 to 74 | 189 |
| Number Of Beneficiaries Age 75 to 84 | 76 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 293 |
| Number Of Male Beneficiaries | 64 |
| Number Of Non Hispanic White Beneficiaries | 333 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 305 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 24 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 63 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9418 |