| National Provider Identifier [NPI]: | 1548297625 |
| Last Name Of The Provider | BUNDY-KELM |
| First Name Of The Provider | ANGELA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 620 S HAYNES AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MILES CITY |
| Zip Code Of The Provider | 593014769 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 97 |
| Number Of Services | 2282 |
| Number Of Medicare Beneficiaries | 401 |
| Total Submitted Charge Amount | 214410.4 |
| Total Medicare Allowed Amount | 87707.42 |
| Total Medicare Payment Amount | 63907.87 |
| Total Medicare Standardized Payment Amount | 72729.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 25 |
| Number Of Drug Services | 483 |
| Number Of Medicare Beneficiaries With Drug Services | 98 |
| Total Drug Submitted ChargeAmount | 43315.9 |
| Total Drug Medicare AllowedAmount | 15829.33 |
| Total Drug Medicare PaymentAmount | 13060.23 |
| Total Drug Medicare Standardized Payment Amount | 13060.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 1799 |
| Number Of Medicare Beneficiaries With Medical Services | 395 |
| Total Medical Submitted Charge Amount | 171094.5 |
| Total Medical Medicare Allowed Amount | 71878.09 |
| Total Medical Medicare Payment Amount | 50847.64 |
| Total Medical Medicare Standardized Payment Amount | 59669.61 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 157 |
| Number Of Beneficiaries Age 75 to 84 | 108 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 244 |
| Number Of Male Beneficiaries | 157 |
| Number Of Non Hispanic White Beneficiaries | 375 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 324 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 77 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0773 |