| National Provider Identifier [NPI]: | 1740282565 |
| Last Name Of The Provider | BENEDETTO |
| First Name Of The Provider | JETTE |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14408 E SPRAGUE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPOKANE VALLEY |
| Zip Code Of The Provider | 992162167 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 77 |
| Number Of Services | 1009 |
| Number Of Medicare Beneficiaries | 104 |
| Total Submitted Charge Amount | 105211.86 |
| Total Medicare Allowed Amount | 40341.11 |
| Total Medicare Payment Amount | 30273.63 |
| Total Medicare Standardized Payment Amount | 30956.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 37 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 1073.9 |
| Total Drug Medicare AllowedAmount | 532.67 |
| Total Drug Medicare PaymentAmount | 515.32 |
| Total Drug Medicare Standardized Payment Amount | 515.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 972 |
| Number Of Medicare Beneficiaries With Medical Services | 104 |
| Total Medical Submitted Charge Amount | 104137.96 |
| Total Medical Medicare Allowed Amount | 39808.44 |
| Total Medical Medicare Payment Amount | 29758.31 |
| Total Medical Medicare Standardized Payment Amount | 30440.88 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 49 |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 86 |
| Number Of Male Beneficiaries | 18 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 89 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 13 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8684 |