| National Provider Identifier [NPI]: | 1740479153 |
| Last Name Of The Provider | DESPAULT |
| First Name Of The Provider | TASHA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7330 SAN PEDRO |
| Street Address 2 Of The Provider | SUITE 400 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782166235 |
| 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 | 26 |
| Number Of Services | 427 |
| Number Of Medicare Beneficiaries | 171 |
| Total Submitted Charge Amount | 17373.4 |
| Total Medicare Allowed Amount | 12235.89 |
| Total Medicare Payment Amount | 9251.5 |
| Total Medicare Standardized Payment Amount | 11093.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 138 |
| Number Of Medicare Beneficiaries With Drug Services | 102 |
| Total Drug Submitted ChargeAmount | 2502.4 |
| Total Drug Medicare AllowedAmount | 1466.51 |
| Total Drug Medicare PaymentAmount | 1420.06 |
| Total Drug Medicare Standardized Payment Amount | 1420.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 289 |
| Number Of Medicare Beneficiaries With Medical Services | 170 |
| Total Medical Submitted Charge Amount | 14871 |
| Total Medical Medicare Allowed Amount | 10769.38 |
| Total Medical Medicare Payment Amount | 7831.44 |
| Total Medical Medicare Standardized Payment Amount | 9673.8 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 105 |
| Number Of Beneficiaries Age 75 to 84 | 42 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 97 |
| Number Of Male Beneficiaries | 74 |
| Number Of Non Hispanic White Beneficiaries | 153 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8196 |