| National Provider Identifier [NPI]: | 1861630444 |
| Last Name Of The Provider | GARRETT |
| First Name Of The Provider | STEPHAN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2911 N TENAYA WAY |
| Street Address 2 Of The Provider | SUITE 105 |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891280464 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 4 |
| Number Of Services | 313 |
| Number Of Medicare Beneficiaries | 19 |
| Total Submitted Charge Amount | 8268 |
| Total Medicare Allowed Amount | 6322.45 |
| Total Medicare Payment Amount | 4697.74 |
| Total Medicare Standardized Payment Amount | 5394.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 171 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 1368 |
| Total Drug Medicare AllowedAmount | 843.59 |
| Total Drug Medicare PaymentAmount | 641.98 |
| Total Drug Medicare Standardized Payment Amount | 641.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 3 |
| Number Of Medical Services | 142 |
| Number Of Medicare Beneficiaries With Medical Services | 19 |
| Total Medical Submitted Charge Amount | 6900 |
| Total Medical Medicare Allowed Amount | 5478.86 |
| Total Medical Medicare Payment Amount | 4055.76 |
| Total Medical Medicare Standardized Payment Amount | 4752.05 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | 0 |
| Number Of Female Beneficiaries | 0 |
| Number Of Male Beneficiaries | 19 |
| 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 | |
| Percent Of With Alzheimers Disease or Dementia | 0 |
| Percent Of With Asthma | 0 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | |
| Percent Of With Hypertension | |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.4462 |