| National Provider Identifier [NPI]: | 1578881082 |
| Last Name Of The Provider | GRIMES |
| First Name Of The Provider | MICHELLE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4315 JAMES CASEY ST |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | AUSTIN |
| Zip Code Of The Provider | 787453365 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 416 |
| Number Of Medicare Beneficiaries | 218 |
| Total Submitted Charge Amount | 14428.35 |
| Total Medicare Allowed Amount | 13273.53 |
| Total Medicare Payment Amount | 11252.01 |
| Total Medicare Standardized Payment Amount | 12632.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 167 |
| Number Of Medicare Beneficiaries With Drug Services | 161 |
| Total Drug Submitted ChargeAmount | 4917.35 |
| Total Drug Medicare AllowedAmount | 4917.35 |
| Total Drug Medicare PaymentAmount | 4817.01 |
| Total Drug Medicare Standardized Payment Amount | 4817.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 249 |
| Number Of Medicare Beneficiaries With Medical Services | 218 |
| Total Medical Submitted Charge Amount | 9511 |
| Total Medical Medicare Allowed Amount | 8356.18 |
| Total Medical Medicare Payment Amount | 6435 |
| Total Medical Medicare Standardized Payment Amount | 7815.2 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 138 |
| Number Of Beneficiaries Age 75 to 84 | 55 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 114 |
| Number Of Male Beneficiaries | 104 |
| Number Of Non Hispanic White Beneficiaries | 191 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 13 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6691 |