| National Provider Identifier [NPI]: | 1457335010 |
| Last Name Of The Provider | ARCHULETA |
| First Name Of The Provider | TRAVIS |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3676 PARKER BLVD |
| Street Address 2 Of The Provider | SUITE 350 |
| City Of The Provider | PUEBLO |
| Zip Code Of The Provider | 810082212 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 121 |
| Number Of Services | 122205 |
| Number Of Medicare Beneficiaries | 829 |
| Total Submitted Charge Amount | 7262128 |
| Total Medicare Allowed Amount | 1945276.07 |
| Total Medicare Payment Amount | 1509192 |
| Total Medicare Standardized Payment Amount | 1504306.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 66 |
| Number Of Drug Services | 115414 |
| Number Of Medicare Beneficiaries With Drug Services | 234 |
| Total Drug Submitted ChargeAmount | 6186782 |
| Total Drug Medicare AllowedAmount | 1626455.02 |
| Total Drug Medicare PaymentAmount | 1265156.21 |
| Total Drug Medicare Standardized Payment Amount | 1265156.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 6791 |
| Number Of Medicare Beneficiaries With Medical Services | 829 |
| Total Medical Submitted Charge Amount | 1075346 |
| Total Medical Medicare Allowed Amount | 318821.05 |
| Total Medical Medicare Payment Amount | 244035.79 |
| Total Medical Medicare Standardized Payment Amount | 239149.8 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 107 |
| Number Of Beneficiaries Age 65 to 74 | 327 |
| Number Of Beneficiaries Age 75 to 84 | 291 |
| Number Of Beneficiaries Age Greater 84 | 104 |
| Number Of Female Beneficiaries | 500 |
| Number Of Male Beneficiaries | 329 |
| Number Of Non Hispanic White Beneficiaries | 618 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 192 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 666 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 163 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 48 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.875 |