| National Provider Identifier [NPI]: | 1932359569 |
| Last Name Of The Provider | EXCELL |
| First Name Of The Provider | EVAN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2080 W SOUTHERN AVE |
| Street Address 2 Of The Provider | STE A1 |
| City Of The Provider | APACHE JUNCTION |
| Zip Code Of The Provider | 851207455 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 1458 |
| Number Of Medicare Beneficiaries | 784 |
| Total Submitted Charge Amount | 175540.5 |
| Total Medicare Allowed Amount | 86930.18 |
| Total Medicare Payment Amount | 59526.64 |
| Total Medicare Standardized Payment Amount | 72672.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 87 |
| Number Of Medicare Beneficiaries With Drug Services | 43 |
| Total Drug Submitted ChargeAmount | 1369.5 |
| Total Drug Medicare AllowedAmount | 567.66 |
| Total Drug Medicare PaymentAmount | 446.97 |
| Total Drug Medicare Standardized Payment Amount | 446.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 1371 |
| Number Of Medicare Beneficiaries With Medical Services | 784 |
| Total Medical Submitted Charge Amount | 174171 |
| Total Medical Medicare Allowed Amount | 86362.52 |
| Total Medical Medicare Payment Amount | 59079.67 |
| Total Medical Medicare Standardized Payment Amount | 72225.81 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 335 |
| Number Of Beneficiaries Age 75 to 84 | 280 |
| Number Of Beneficiaries Age Greater 84 | 110 |
| Number Of Female Beneficiaries | 448 |
| Number Of Male Beneficiaries | 336 |
| Number Of Non Hispanic White Beneficiaries | 747 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 745 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9816 |