| National Provider Identifier [NPI]: | 1700222437 |
| Last Name Of The Provider | HENDERSON |
| First Name Of The Provider | TRAVIS |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 310 TORBETT ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | RICHLAND |
| Zip Code Of The Provider | 993542604 |
| 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 | 50 |
| Number Of Services | 884 |
| Number Of Medicare Beneficiaries | 471 |
| Total Submitted Charge Amount | 66228 |
| Total Medicare Allowed Amount | 38414.17 |
| Total Medicare Payment Amount | 24732.07 |
| Total Medicare Standardized Payment Amount | 30589.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 160 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 790 |
| Total Drug Medicare AllowedAmount | 363.93 |
| Total Drug Medicare PaymentAmount | 220.57 |
| Total Drug Medicare Standardized Payment Amount | 220.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 724 |
| Number Of Medicare Beneficiaries With Medical Services | 471 |
| Total Medical Submitted Charge Amount | 65438 |
| Total Medical Medicare Allowed Amount | 38050.24 |
| Total Medical Medicare Payment Amount | 24511.5 |
| Total Medical Medicare Standardized Payment Amount | 30368.86 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 219 |
| Number Of Beneficiaries Age 75 to 84 | 134 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 272 |
| Number Of Male Beneficiaries | 199 |
| Number Of Non Hispanic White Beneficiaries | 429 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 430 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.892 |