| National Provider Identifier [NPI]: | 1174884290 |
| Last Name Of The Provider | TUCKER |
| First Name Of The Provider | BRADY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 S 11TH AVE |
| Street Address 2 Of The Provider | SUITE 303 |
| City Of The Provider | POCATELLO |
| Zip Code Of The Provider | 832014835 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 1143 |
| Number Of Medicare Beneficiaries | 277 |
| Total Submitted Charge Amount | 63170.08 |
| Total Medicare Allowed Amount | 37364.5 |
| Total Medicare Payment Amount | 27630.99 |
| Total Medicare Standardized Payment Amount | 34161.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 516 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 444.08 |
| Total Drug Medicare AllowedAmount | 378.01 |
| Total Drug Medicare PaymentAmount | 353.56 |
| Total Drug Medicare Standardized Payment Amount | 353.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 627 |
| Number Of Medicare Beneficiaries With Medical Services | 277 |
| Total Medical Submitted Charge Amount | 62726 |
| Total Medical Medicare Allowed Amount | 36986.49 |
| Total Medical Medicare Payment Amount | 27277.43 |
| Total Medical Medicare Standardized Payment Amount | 33807.83 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 115 |
| Number Of Beneficiaries Age 75 to 84 | 107 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 140 |
| Number Of Male Beneficiaries | 137 |
| Number Of Non Hispanic White Beneficiaries | 261 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 265 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 24 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3493 |