| National Provider Identifier [NPI]: | 1962585752 |
| Last Name Of The Provider | WEISZHAAR |
| First Name Of The Provider | TRAVIS |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | P.A.-C. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 PROFESSIONAL PLZ |
| Street Address 2 Of The Provider | |
| City Of The Provider | REXBURG |
| Zip Code Of The Provider | 834402024 |
| 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 | 46 |
| Number Of Services | 1310 |
| Number Of Medicare Beneficiaries | 247 |
| Total Submitted Charge Amount | 74656 |
| Total Medicare Allowed Amount | 32372.33 |
| Total Medicare Payment Amount | 19978.72 |
| Total Medicare Standardized Payment Amount | 27419.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 335 |
| Number Of Medicare Beneficiaries With Drug Services | 63 |
| Total Drug Submitted ChargeAmount | 4139 |
| Total Drug Medicare AllowedAmount | 272.87 |
| Total Drug Medicare PaymentAmount | 173.44 |
| Total Drug Medicare Standardized Payment Amount | 173.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 975 |
| Number Of Medicare Beneficiaries With Medical Services | 247 |
| Total Medical Submitted Charge Amount | 70517 |
| Total Medical Medicare Allowed Amount | 32099.46 |
| Total Medical Medicare Payment Amount | 19805.28 |
| Total Medical Medicare Standardized Payment Amount | 27245.65 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 104 |
| Number Of Beneficiaries Age 75 to 84 | 85 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 135 |
| Number Of Male Beneficiaries | 112 |
| Number Of Non Hispanic White Beneficiaries | 236 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 219 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 22 |
| Percent Of With Hypertension | 39 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7633 |