| National Provider Identifier [NPI]: | 1285635136 |
| Last Name Of The Provider | STREET |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | PA C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1600 DIVISION RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | GREAT FALLS |
| Zip Code Of The Provider | 594041921 |
| 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 | 31 |
| Number Of Services | 775 |
| Number Of Medicare Beneficiaries | 522 |
| Total Submitted Charge Amount | 74153.17 |
| Total Medicare Allowed Amount | 56718.78 |
| Total Medicare Payment Amount | 36853.52 |
| Total Medicare Standardized Payment Amount | 44979.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 17 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 333.37 |
| Total Drug Medicare AllowedAmount | 287.24 |
| Total Drug Medicare PaymentAmount | 252.92 |
| Total Drug Medicare Standardized Payment Amount | 252.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 758 |
| Number Of Medicare Beneficiaries With Medical Services | 522 |
| Total Medical Submitted Charge Amount | 73819.8 |
| Total Medical Medicare Allowed Amount | 56431.54 |
| Total Medical Medicare Payment Amount | 36600.6 |
| Total Medical Medicare Standardized Payment Amount | 44726.42 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 225 |
| Number Of Beneficiaries Age 75 to 84 | 163 |
| Number Of Beneficiaries Age Greater 84 | 66 |
| Number Of Female Beneficiaries | 291 |
| Number Of Male Beneficiaries | 231 |
| Number Of Non Hispanic White Beneficiaries | 481 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 22 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 452 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 70 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9609 |