| National Provider Identifier [NPI]: | 1134176340 |
| Last Name Of The Provider | MARTIN |
| First Name Of The Provider | THERESA |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11212 SUNRISE BLVD E |
| Street Address 2 Of The Provider | #201 |
| City Of The Provider | PUYALLUP |
| Zip Code Of The Provider | 983748847 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 305 |
| Number Of Medicare Beneficiaries | 84 |
| Total Submitted Charge Amount | 209952 |
| Total Medicare Allowed Amount | 24149.47 |
| Total Medicare Payment Amount | 18421.65 |
| Total Medicare Standardized Payment Amount | 19213.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 97 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 20508 |
| Total Drug Medicare AllowedAmount | 8988.13 |
| Total Drug Medicare PaymentAmount | 6971.55 |
| Total Drug Medicare Standardized Payment Amount | 6971.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 208 |
| Number Of Medicare Beneficiaries With Medical Services | 84 |
| Total Medical Submitted Charge Amount | 189444 |
| Total Medical Medicare Allowed Amount | 15161.34 |
| Total Medical Medicare Payment Amount | 11450.1 |
| Total Medical Medicare Standardized Payment Amount | 12241.5 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 34 |
| Number Of Beneficiaries Age 75 to 84 | 26 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 54 |
| Number Of Male Beneficiaries | 30 |
| 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 | 71 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 73 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1768 |