| National Provider Identifier [NPI]: | 1255390472 |
| Last Name Of The Provider | TATE |
| First Name Of The Provider | CRYSTAL |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 375 MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ECRU |
| Zip Code Of The Provider | 388419118 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 2621 |
| Number Of Medicare Beneficiaries | 1268 |
| Total Submitted Charge Amount | 99255.07 |
| Total Medicare Allowed Amount | 72324.42 |
| Total Medicare Payment Amount | 70554.73 |
| Total Medicare Standardized Payment Amount | 74020.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 1325 |
| Number Of Medicare Beneficiaries With Drug Services | 1254 |
| Total Drug Submitted ChargeAmount | 58721.39 |
| Total Drug Medicare AllowedAmount | 42964.58 |
| Total Drug Medicare PaymentAmount | 42102.25 |
| Total Drug Medicare Standardized Payment Amount | 42102.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 6 |
| Number Of Medical Services | 1296 |
| Number Of Medicare Beneficiaries With Medical Services | 1251 |
| Total Medical Submitted Charge Amount | 40533.68 |
| Total Medical Medicare Allowed Amount | 29359.84 |
| Total Medical Medicare Payment Amount | 28452.48 |
| Total Medical Medicare Standardized Payment Amount | 31918.69 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 146 |
| Number Of Beneficiaries Age 65 to 74 | 462 |
| Number Of Beneficiaries Age 75 to 84 | 512 |
| Number Of Beneficiaries Age Greater 84 | 148 |
| Number Of Female Beneficiaries | 709 |
| Number Of Male Beneficiaries | 559 |
| Number Of Non Hispanic White Beneficiaries | 1167 |
| 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 | 1039 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 229 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 8 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8413 |