| National Provider Identifier [NPI]: | 1144218868 |
| Last Name Of The Provider | STELLY |
| First Name Of The Provider | DEIDRE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 112 CHAMPAGNE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BREAUX BRIDGE |
| Zip Code Of The Provider | 705173852 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 1923 |
| Number Of Medicare Beneficiaries | 467 |
| Total Submitted Charge Amount | 179762 |
| Total Medicare Allowed Amount | 129276.02 |
| Total Medicare Payment Amount | 83017.15 |
| Total Medicare Standardized Payment Amount | 90525.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 212 |
| Number Of Medicare Beneficiaries With Drug Services | 82 |
| Total Drug Submitted ChargeAmount | 2656 |
| Total Drug Medicare AllowedAmount | 993.63 |
| Total Drug Medicare PaymentAmount | 661.48 |
| Total Drug Medicare Standardized Payment Amount | 661.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 1711 |
| Number Of Medicare Beneficiaries With Medical Services | 467 |
| Total Medical Submitted Charge Amount | 177106 |
| Total Medical Medicare Allowed Amount | 128282.39 |
| Total Medical Medicare Payment Amount | 82355.67 |
| Total Medical Medicare Standardized Payment Amount | 89864.38 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 225 |
| Number Of Beneficiaries Age 75 to 84 | 149 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 296 |
| Number Of Male Beneficiaries | 171 |
| Number Of Non Hispanic White Beneficiaries | 402 |
| 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 | 391 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 76 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 0.9719 |