| National Provider Identifier [NPI]: | 1871571356 |
| Last Name Of The Provider | GUNNISON |
| First Name Of The Provider | ALICE |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | PA C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2406 WEST BROADWAY |
| Street Address 2 Of The Provider | JENCARE NEIGHBORHOOD MEDICAL CENTER WEST BROADWAY, LLC |
| City Of The Provider | LOUISVILLE |
| Zip Code Of The Provider | 40211 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 556 |
| Number Of Medicare Beneficiaries | 143 |
| Total Submitted Charge Amount | 42661 |
| Total Medicare Allowed Amount | 35937.76 |
| Total Medicare Payment Amount | 24636.5 |
| Total Medicare Standardized Payment Amount | 30334.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 122 |
| Number Of Medicare Beneficiaries With Drug Services | 96 |
| Total Drug Submitted ChargeAmount | 11193 |
| Total Drug Medicare AllowedAmount | 8686.27 |
| Total Drug Medicare PaymentAmount | 8511.68 |
| Total Drug Medicare Standardized Payment Amount | 8511.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 434 |
| Number Of Medicare Beneficiaries With Medical Services | 143 |
| Total Medical Submitted Charge Amount | 31468 |
| Total Medical Medicare Allowed Amount | 27251.49 |
| Total Medical Medicare Payment Amount | 16124.82 |
| Total Medical Medicare Standardized Payment Amount | 21823.24 |
| Average Age Of Beneficiaries | 51 |
| Number Of Beneficiaries Age Less65 | 129 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 38 |
| Number Of Male Beneficiaries | 105 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 90 |
| 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 | 37 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 106 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 13 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 15 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.62 |