| National Provider Identifier [NPI]: | 1184864860 |
| Last Name Of The Provider | MOW |
| First Name Of The Provider | ANDREA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2475 E BROADWAY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | HELENA |
| Zip Code Of The Provider | 596014928 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 8 |
| Number Of Services | 1319 |
| Number Of Medicare Beneficiaries | 154 |
| Total Submitted Charge Amount | 268415 |
| Total Medicare Allowed Amount | 115267 |
| Total Medicare Payment Amount | 88892.45 |
| Total Medicare Standardized Payment Amount | 88308.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 8 |
| Number Of Medical Services | 1319 |
| Number Of Medicare Beneficiaries With Medical Services | 154 |
| Total Medical Submitted Charge Amount | 268415 |
| Total Medical Medicare Allowed Amount | 115267 |
| Total Medical Medicare Payment Amount | 88892.45 |
| Total Medical Medicare Standardized Payment Amount | 88308.62 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 25 |
| Number Of Beneficiaries Age 75 to 84 | 36 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 87 |
| Number Of Male Beneficiaries | 67 |
| Number Of Non Hispanic White Beneficiaries | 142 |
| Number Of Black or African American Beneficiaries | |
| 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 | 66 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 88 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 61 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 74 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 44 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4719 |