| National Provider Identifier [NPI]: | 1922058833 |
| Last Name Of The Provider | SCHANEMAN |
| First Name Of The Provider | GRANT |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | O.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 257 JOHNSTOWN CENTER DR |
| Street Address 2 Of The Provider | SUITE 107 |
| City Of The Provider | JOHNSTOWN |
| Zip Code Of The Provider | 805349073 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 1428 |
| Number Of Medicare Beneficiaries | 997 |
| Total Submitted Charge Amount | 240096 |
| Total Medicare Allowed Amount | 162480.76 |
| Total Medicare Payment Amount | 115263.51 |
| Total Medicare Standardized Payment Amount | 115367.21 |
| 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 | 1428 |
| Number Of Medicare Beneficiaries With Medical Services | 997 |
| Total Medical Submitted Charge Amount | 240096 |
| Total Medical Medicare Allowed Amount | 162480.76 |
| Total Medical Medicare Payment Amount | 115263.51 |
| Total Medical Medicare Standardized Payment Amount | 115367.21 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 117 |
| Number Of Beneficiaries Age 65 to 74 | 229 |
| Number Of Beneficiaries Age 75 to 84 | 250 |
| Number Of Beneficiaries Age Greater 84 | 401 |
| Number Of Female Beneficiaries | 675 |
| Number Of Male Beneficiaries | 322 |
| Number Of Non Hispanic White Beneficiaries | 874 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 99 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 234 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 763 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 66 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 53 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 23 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.0029 |