| National Provider Identifier [NPI]: | 1255330965 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | COLLEEN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 HEALTHY PL |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | PATASKALA |
| Zip Code Of The Provider | 430627067 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 847 |
| Number Of Medicare Beneficiaries | 156 |
| Total Submitted Charge Amount | 61437 |
| Total Medicare Allowed Amount | 50324.35 |
| Total Medicare Payment Amount | 35501.51 |
| Total Medicare Standardized Payment Amount | 37249.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 155 |
| Number Of Medicare Beneficiaries With Drug Services | 95 |
| Total Drug Submitted ChargeAmount | 5916 |
| Total Drug Medicare AllowedAmount | 4635.12 |
| Total Drug Medicare PaymentAmount | 4514.86 |
| Total Drug Medicare Standardized Payment Amount | 4514.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 692 |
| Number Of Medicare Beneficiaries With Medical Services | 156 |
| Total Medical Submitted Charge Amount | 55521 |
| Total Medical Medicare Allowed Amount | 45689.23 |
| Total Medical Medicare Payment Amount | 30986.65 |
| Total Medical Medicare Standardized Payment Amount | 32734.97 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | 30 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 108 |
| Number Of Male Beneficiaries | 48 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 120 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 36 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 20 |
| 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 | 0.8903 |