| National Provider Identifier [NPI]: | 1639161102 |
| Last Name Of The Provider | HENDERSON |
| First Name Of The Provider | AUDREY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1109 MEDICAL CENTER DR |
| Street Address 2 Of The Provider | SUITE 3 |
| City Of The Provider | AUGUSTA |
| Zip Code Of The Provider | 309096644 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 470 |
| Number Of Medicare Beneficiaries | 118 |
| Total Submitted Charge Amount | 33645 |
| Total Medicare Allowed Amount | 28953.65 |
| Total Medicare Payment Amount | 19767.23 |
| Total Medicare Standardized Payment Amount | 23233.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 27 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 1070 |
| Total Drug Medicare AllowedAmount | 702.56 |
| Total Drug Medicare PaymentAmount | 687.92 |
| Total Drug Medicare Standardized Payment Amount | 687.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 443 |
| Number Of Medicare Beneficiaries With Medical Services | 118 |
| Total Medical Submitted Charge Amount | 32575 |
| Total Medical Medicare Allowed Amount | 28251.09 |
| Total Medical Medicare Payment Amount | 19079.31 |
| Total Medical Medicare Standardized Payment Amount | 22545.83 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 57 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 89 |
| Number Of Male Beneficiaries | 29 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 86 |
| 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 | 97 |
| 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 | |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 13 |
| 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 | 1.034 |