| National Provider Identifier [NPI]: | 1578586400 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | JASON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M D |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 103 JOHN MADDOX DR NW |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROME |
| Zip Code Of The Provider | 301651419 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 83 |
| Number Of Services | 22829 |
| Number Of Medicare Beneficiaries | 2753 |
| Total Submitted Charge Amount | 2820920 |
| Total Medicare Allowed Amount | 1176122.52 |
| Total Medicare Payment Amount | 847458.73 |
| Total Medicare Standardized Payment Amount | 904349.2 |
| 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 | 83 |
| Number Of Medical Services | 22829 |
| Number Of Medicare Beneficiaries With Medical Services | 2753 |
| Total Medical Submitted Charge Amount | 2820920 |
| Total Medical Medicare Allowed Amount | 1176122.52 |
| Total Medical Medicare Payment Amount | 847458.73 |
| Total Medical Medicare Standardized Payment Amount | 904349.2 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 194 |
| Number Of Beneficiaries Age 65 to 74 | 1255 |
| Number Of Beneficiaries Age 75 to 84 | 936 |
| Number Of Beneficiaries Age Greater 84 | 368 |
| Number Of Female Beneficiaries | 1381 |
| Number Of Male Beneficiaries | 1372 |
| Number Of Non Hispanic White Beneficiaries | 2693 |
| Number Of Black or African American Beneficiaries | 29 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2496 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 257 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0204 |