| National Provider Identifier [NPI]: | 1134191018 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | DUSTIN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 115 S PARK AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | EAGLE GROVE |
| Zip Code Of The Provider | 505332219 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 744 |
| Number Of Medicare Beneficiaries | 285 |
| Total Submitted Charge Amount | 27410.5 |
| Total Medicare Allowed Amount | 14763.95 |
| Total Medicare Payment Amount | 10594.09 |
| Total Medicare Standardized Payment Amount | 11280.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 159 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 1197.5 |
| Total Drug Medicare AllowedAmount | 841.65 |
| Total Drug Medicare PaymentAmount | 770.03 |
| Total Drug Medicare Standardized Payment Amount | 770.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 585 |
| Number Of Medicare Beneficiaries With Medical Services | 270 |
| Total Medical Submitted Charge Amount | 26213 |
| Total Medical Medicare Allowed Amount | 13922.3 |
| Total Medical Medicare Payment Amount | 9824.06 |
| Total Medical Medicare Standardized Payment Amount | 10510.17 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 87 |
| Number Of Beneficiaries Age 75 to 84 | 88 |
| Number Of Beneficiaries Age Greater 84 | 69 |
| Number Of Female Beneficiaries | 185 |
| Number Of Male Beneficiaries | 100 |
| 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 | 220 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 65 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2958 |