| National Provider Identifier [NPI]: | 1861453680 |
| Last Name Of The Provider | BOUDEWIJN |
| First Name Of The Provider | ROB |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6 E CHESTNUT ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUGUSTA |
| Zip Code Of The Provider | 043305717 |
| 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 | 20 |
| Number Of Services | 681 |
| Number Of Medicare Beneficiaries | 605 |
| Total Submitted Charge Amount | 141379 |
| Total Medicare Allowed Amount | 57484.68 |
| Total Medicare Payment Amount | 42250.06 |
| Total Medicare Standardized Payment Amount | 52262.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 681 |
| Number Of Medicare Beneficiaries With Medical Services | 605 |
| Total Medical Submitted Charge Amount | 141379 |
| Total Medical Medicare Allowed Amount | 57484.68 |
| Total Medical Medicare Payment Amount | 42250.06 |
| Total Medical Medicare Standardized Payment Amount | 52262.48 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 216 |
| Number Of Beneficiaries Age 65 to 74 | 143 |
| Number Of Beneficiaries Age 75 to 84 | 135 |
| Number Of Beneficiaries Age Greater 84 | 111 |
| Number Of Female Beneficiaries | 342 |
| Number Of Male Beneficiaries | 263 |
| Number Of Non Hispanic White Beneficiaries | 590 |
| 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 | 238 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 367 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 50 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6668 |