| National Provider Identifier [NPI]: | 1235367236 |
| Last Name Of The Provider | HUMPHREY |
| First Name Of The Provider | CHRISTINE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3201 DATA DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | RANCHO CORDOVA |
| Zip Code Of The Provider | 956707374 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 284 |
| Number Of Medicare Beneficiaries | 93 |
| Total Submitted Charge Amount | 29399.01 |
| Total Medicare Allowed Amount | 20001.98 |
| Total Medicare Payment Amount | 15315.51 |
| Total Medicare Standardized Payment Amount | 14738.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 32 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 644.01 |
| Total Drug Medicare AllowedAmount | 229.12 |
| Total Drug Medicare PaymentAmount | 221.89 |
| Total Drug Medicare Standardized Payment Amount | 221.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 252 |
| Number Of Medicare Beneficiaries With Medical Services | 93 |
| Total Medical Submitted Charge Amount | 28755 |
| Total Medical Medicare Allowed Amount | 19772.86 |
| Total Medical Medicare Payment Amount | 15093.62 |
| Total Medical Medicare Standardized Payment Amount | 14516.33 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 26 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 65 |
| Number Of Male Beneficiaries | 28 |
| Number Of Non Hispanic White Beneficiaries | 61 |
| 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 | 32 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 0 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 13 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8688 |