| National Provider Identifier [NPI]: | 1518047588 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | BRUCE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4017 RAWLINS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHEYENNE |
| Zip Code Of The Provider | 820011800 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 1093 |
| Number Of Medicare Beneficiaries | 216 |
| Total Submitted Charge Amount | 480111.49 |
| Total Medicare Allowed Amount | 123276.78 |
| Total Medicare Payment Amount | 93775.6 |
| Total Medicare Standardized Payment Amount | 92510.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 266 |
| Number Of Medicare Beneficiaries With Drug Services | 49 |
| Total Drug Submitted ChargeAmount | 30689.44 |
| Total Drug Medicare AllowedAmount | 14358 |
| Total Drug Medicare PaymentAmount | 11196.27 |
| Total Drug Medicare Standardized Payment Amount | 11196.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 827 |
| Number Of Medicare Beneficiaries With Medical Services | 216 |
| Total Medical Submitted Charge Amount | 449422.05 |
| Total Medical Medicare Allowed Amount | 108918.78 |
| Total Medical Medicare Payment Amount | 82579.33 |
| Total Medical Medicare Standardized Payment Amount | 81314.52 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 107 |
| Number Of Beneficiaries Age 75 to 84 | 57 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 127 |
| Number Of Male Beneficiaries | 89 |
| Number Of Non Hispanic White Beneficiaries | 186 |
| 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 | 176 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 70 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0576 |