| National Provider Identifier [NPI]: | 1114234325 |
| Last Name Of The Provider | KRAGT |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MS, PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 MICHIGAN ST NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 495032560 |
| 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 | 14 |
| Number Of Services | 115 |
| Number Of Medicare Beneficiaries | 110 |
| Total Submitted Charge Amount | 42855 |
| Total Medicare Allowed Amount | 12023.23 |
| Total Medicare Payment Amount | 9291.51 |
| Total Medicare Standardized Payment Amount | 11124.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 115 |
| Number Of Medicare Beneficiaries With Medical Services | 110 |
| Total Medical Submitted Charge Amount | 42855 |
| Total Medical Medicare Allowed Amount | 12023.23 |
| Total Medical Medicare Payment Amount | 9291.51 |
| Total Medical Medicare Standardized Payment Amount | 11124.64 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 18 |
| Number Of Beneficiaries Age 75 to 84 | 13 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 65 |
| Number Of Male Beneficiaries | 45 |
| Number Of Non Hispanic White Beneficiaries | 80 |
| Number Of Black or African American Beneficiaries | 18 |
| 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 | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 50 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 60 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 53 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.9141 |