| National Provider Identifier [NPI]: | 1982773099 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | EVA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D., M.P.H. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 AIRPORT ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | HOOPA |
| Zip Code Of The Provider | 95546 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Preventive Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 72 |
| Number Of Services | 1204 |
| Number Of Medicare Beneficiaries | 170 |
| Total Submitted Charge Amount | 82950.08 |
| Total Medicare Allowed Amount | 55939.17 |
| Total Medicare Payment Amount | 41384.46 |
| Total Medicare Standardized Payment Amount | 40871.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 110 |
| Number Of Medicare Beneficiaries With Drug Services | 57 |
| Total Drug Submitted ChargeAmount | 3222.9 |
| Total Drug Medicare AllowedAmount | 1009.1 |
| Total Drug Medicare PaymentAmount | 984.72 |
| Total Drug Medicare Standardized Payment Amount | 984.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 65 |
| Number Of Medical Services | 1094 |
| Number Of Medicare Beneficiaries With Medical Services | 168 |
| Total Medical Submitted Charge Amount | 79727.18 |
| Total Medical Medicare Allowed Amount | 54930.07 |
| Total Medical Medicare Payment Amount | 40399.74 |
| Total Medical Medicare Standardized Payment Amount | 39886.84 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 60 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 111 |
| Number Of Male Beneficiaries | 59 |
| 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 | 155 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 95 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 75 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 22 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2642 |