| National Provider Identifier [NPI]: | 1689711715 |
| Last Name Of The Provider | PUHAK |
| First Name Of The Provider | PENNY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | ETC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 104 CENTER AVE STE 100 |
| Street Address 2 Of The Provider | |
| City Of The Provider | KODIAK |
| Zip Code Of The Provider | 996156393 |
| State Code Of The Provider | AK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 318 |
| Number Of Medicare Beneficiaries | 84 |
| Total Submitted Charge Amount | 43951 |
| Total Medicare Allowed Amount | 14072.95 |
| Total Medicare Payment Amount | 10000.24 |
| Total Medicare Standardized Payment Amount | 9534.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 2574 |
| Total Drug Medicare AllowedAmount | 515.83 |
| Total Drug Medicare PaymentAmount | 505.57 |
| Total Drug Medicare Standardized Payment Amount | 505.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 282 |
| Number Of Medicare Beneficiaries With Medical Services | 84 |
| Total Medical Submitted Charge Amount | 41377 |
| Total Medical Medicare Allowed Amount | 13557.12 |
| Total Medical Medicare Payment Amount | 9494.67 |
| Total Medical Medicare Standardized Payment Amount | 9029.37 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 40 |
| Number Of Beneficiaries Age 75 to 84 | 22 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 49 |
| Number Of Male Beneficiaries | 35 |
| 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 | 63 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 23 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0302 |