| National Provider Identifier [NPI]: | 1831199777 |
| Last Name Of The Provider | CAUDILL |
| First Name Of The Provider | GREGORY |
| 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 | 17910 TALBOT RD S |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | RENTON |
| Zip Code Of The Provider | 980556237 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 75 |
| Number Of Services | 1289 |
| Number Of Medicare Beneficiaries | 246 |
| Total Submitted Charge Amount | 164430.2 |
| Total Medicare Allowed Amount | 47272.95 |
| Total Medicare Payment Amount | 34946.34 |
| Total Medicare Standardized Payment Amount | 37481.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 717 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 14662 |
| Total Drug Medicare AllowedAmount | 7056.97 |
| Total Drug Medicare PaymentAmount | 5053.39 |
| Total Drug Medicare Standardized Payment Amount | 5053.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 572 |
| Number Of Medicare Beneficiaries With Medical Services | 246 |
| Total Medical Submitted Charge Amount | 149768.2 |
| Total Medical Medicare Allowed Amount | 40215.98 |
| Total Medical Medicare Payment Amount | 29892.95 |
| Total Medical Medicare Standardized Payment Amount | 32428.52 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 108 |
| Number Of Beneficiaries Age 75 to 84 | 72 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 159 |
| Number Of Male Beneficiaries | 87 |
| Number Of Non Hispanic White Beneficiaries | 231 |
| Number Of Black or African American Beneficiaries | |
| 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 | 205 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 73 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.253 |