| National Provider Identifier [NPI]: | 1881704252 |
| Last Name Of The Provider | STOCKBRIDGE |
| First Name Of The Provider | GLENN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3912 TANGLEWOOD LANE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ODESSA |
| Zip Code Of The Provider | 797627165 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 2769 |
| Number Of Medicare Beneficiaries | 708 |
| Total Submitted Charge Amount | 191826 |
| Total Medicare Allowed Amount | 142835.35 |
| Total Medicare Payment Amount | 100722.85 |
| Total Medicare Standardized Payment Amount | 109371.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 2769 |
| Number Of Medicare Beneficiaries With Medical Services | 708 |
| Total Medical Submitted Charge Amount | 191826 |
| Total Medical Medicare Allowed Amount | 142835.35 |
| Total Medical Medicare Payment Amount | 100722.85 |
| Total Medical Medicare Standardized Payment Amount | 109371.98 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 217 |
| Number Of Beneficiaries Age 75 to 84 | 281 |
| Number Of Beneficiaries Age Greater 84 | 148 |
| Number Of Female Beneficiaries | 447 |
| Number Of Male Beneficiaries | 261 |
| Number Of Non Hispanic White Beneficiaries | 530 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 153 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 581 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 127 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5604 |