| National Provider Identifier [NPI]: | 1851721401 |
| Last Name Of The Provider | PETRIE |
| First Name Of The Provider | JOSEPH |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2001 E QUAIL RUN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | EMMETT |
| Zip Code Of The Provider | 836175059 |
| 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 | 23 |
| Number Of Services | 411 |
| Number Of Medicare Beneficiaries | 267 |
| Total Submitted Charge Amount | 45098 |
| Total Medicare Allowed Amount | 18188.65 |
| Total Medicare Payment Amount | 12634.97 |
| Total Medicare Standardized Payment Amount | 16305.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 40 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 607 |
| Total Drug Medicare AllowedAmount | 308.91 |
| Total Drug Medicare PaymentAmount | 286.37 |
| Total Drug Medicare Standardized Payment Amount | 286.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 371 |
| Number Of Medicare Beneficiaries With Medical Services | 267 |
| Total Medical Submitted Charge Amount | 44491 |
| Total Medical Medicare Allowed Amount | 17879.74 |
| Total Medical Medicare Payment Amount | 12348.6 |
| Total Medical Medicare Standardized Payment Amount | 16019.51 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 91 |
| Number Of Beneficiaries Age 75 to 84 | 74 |
| Number Of Beneficiaries Age Greater 84 | 39 |
| Number Of Female Beneficiaries | 155 |
| Number Of Male Beneficiaries | 112 |
| Number Of Non Hispanic White Beneficiaries | 219 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 189 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 78 |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.972 |