| National Provider Identifier [NPI]: | 1740522648 |
| Last Name Of The Provider | WHITE |
| First Name Of The Provider | MONICA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 219 CAPITOL ST |
| Street Address 2 Of The Provider | SUITE 5 |
| City Of The Provider | AUGUSTA |
| Zip Code Of The Provider | 043306235 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 588 |
| Number Of Medicare Beneficiaries | 189 |
| Total Submitted Charge Amount | 72239.51 |
| Total Medicare Allowed Amount | 31131.31 |
| Total Medicare Payment Amount | 24244.9 |
| Total Medicare Standardized Payment Amount | 29923.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 19 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 294 |
| Total Drug Medicare AllowedAmount | 143.31 |
| Total Drug Medicare PaymentAmount | 139.29 |
| Total Drug Medicare Standardized Payment Amount | 139.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 569 |
| Number Of Medicare Beneficiaries With Medical Services | 189 |
| Total Medical Submitted Charge Amount | 71945.51 |
| Total Medical Medicare Allowed Amount | 30988 |
| Total Medical Medicare Payment Amount | 24105.61 |
| Total Medical Medicare Standardized Payment Amount | 29784.5 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 87 |
| Number Of Beneficiaries Age 65 to 74 | 54 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 122 |
| Number Of Male Beneficiaries | 67 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 64 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 125 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 48 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0606 |