| National Provider Identifier [NPI]: | 1447201389 |
| Last Name Of The Provider | PHELPS |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 MERCADO ST |
| Street Address 2 Of The Provider | STE 202 |
| City Of The Provider | DURANGO |
| Zip Code Of The Provider | 813017300 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 1375 |
| Number Of Medicare Beneficiaries | 197 |
| Total Submitted Charge Amount | 171235 |
| Total Medicare Allowed Amount | 57514.03 |
| Total Medicare Payment Amount | 42246.54 |
| Total Medicare Standardized Payment Amount | 45480.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 871 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 42850 |
| Total Drug Medicare AllowedAmount | 24626.09 |
| Total Drug Medicare PaymentAmount | 18387.78 |
| Total Drug Medicare Standardized Payment Amount | 18387.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 504 |
| Number Of Medicare Beneficiaries With Medical Services | 197 |
| Total Medical Submitted Charge Amount | 128385 |
| Total Medical Medicare Allowed Amount | 32887.94 |
| Total Medical Medicare Payment Amount | 23858.76 |
| Total Medical Medicare Standardized Payment Amount | 27092.82 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 103 |
| Number Of Beneficiaries Age 75 to 84 | 48 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 119 |
| Number Of Male Beneficiaries | 78 |
| Number Of Non Hispanic White Beneficiaries | 174 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 173 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 26 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 64 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1678 |