| National Provider Identifier [NPI]: | 1669410528 |
| Last Name Of The Provider | GRANT |
| First Name Of The Provider | SARAH |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1111 LEFFINGWELL AVE NE |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 495256406 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 579 |
| Number Of Medicare Beneficiaries | 141 |
| Total Submitted Charge Amount | 84758.6 |
| Total Medicare Allowed Amount | 22230.46 |
| Total Medicare Payment Amount | 16502.71 |
| Total Medicare Standardized Payment Amount | 19242.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 213 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 8949.8 |
| Total Drug Medicare AllowedAmount | 3988.85 |
| Total Drug Medicare PaymentAmount | 3127.32 |
| Total Drug Medicare Standardized Payment Amount | 3127.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 366 |
| Number Of Medicare Beneficiaries With Medical Services | 140 |
| Total Medical Submitted Charge Amount | 75808.8 |
| Total Medical Medicare Allowed Amount | 18241.61 |
| Total Medical Medicare Payment Amount | 13375.39 |
| Total Medical Medicare Standardized Payment Amount | 16114.82 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 60 |
| Number Of Beneficiaries Age 75 to 84 | 32 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 91 |
| Number Of Male Beneficiaries | 50 |
| Number Of Non Hispanic White Beneficiaries | 123 |
| 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 | 108 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 70 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5012 |