| National Provider Identifier [NPI]: | 1205120805 |
| Last Name Of The Provider | GAN |
| First Name Of The Provider | WAND |
| Middle Initial Of The Provider | Y |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4420 76TH ST NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MARYSVILLE |
| Zip Code Of The Provider | 982703726 |
| 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 | 57 |
| Number Of Services | 371 |
| Number Of Medicare Beneficiaries | 87 |
| Total Submitted Charge Amount | 23084.25 |
| Total Medicare Allowed Amount | 10250.42 |
| Total Medicare Payment Amount | 7872.21 |
| Total Medicare Standardized Payment Amount | 8261.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 139 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 1057.5 |
| Total Drug Medicare AllowedAmount | 538.71 |
| Total Drug Medicare PaymentAmount | 520.85 |
| Total Drug Medicare Standardized Payment Amount | 520.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 232 |
| Number Of Medicare Beneficiaries With Medical Services | 87 |
| Total Medical Submitted Charge Amount | 22026.75 |
| Total Medical Medicare Allowed Amount | 9711.71 |
| Total Medical Medicare Payment Amount | 7351.36 |
| Total Medical Medicare Standardized Payment Amount | 7740.43 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 34 |
| Number Of Beneficiaries Age 75 to 84 | 23 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 53 |
| Number Of Male Beneficiaries | 34 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 34 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.3087 |