| National Provider Identifier [NPI]: | 1417996448 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | JERRY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 902 S VIENNA ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | RUSTON |
| Zip Code Of The Provider | 712705830 |
| 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 | 15 |
| Number Of Services | 762 |
| Number Of Medicare Beneficiaries | 98 |
| Total Submitted Charge Amount | 20213.47 |
| Total Medicare Allowed Amount | 12271.72 |
| Total Medicare Payment Amount | 9821.21 |
| Total Medicare Standardized Payment Amount | 7495.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 373 |
| Number Of Medicare Beneficiaries With Drug Services | 80 |
| Total Drug Submitted ChargeAmount | 3970 |
| Total Drug Medicare AllowedAmount | 1274.91 |
| Total Drug Medicare PaymentAmount | 1046.49 |
| Total Drug Medicare Standardized Payment Amount | 1046.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 11 |
| Number Of Medical Services | 389 |
| Number Of Medicare Beneficiaries With Medical Services | 98 |
| Total Medical Submitted Charge Amount | 16243.47 |
| Total Medical Medicare Allowed Amount | 10996.81 |
| Total Medical Medicare Payment Amount | 8774.72 |
| Total Medical Medicare Standardized Payment Amount | 6448.89 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 60 |
| Number Of Beneficiaries Age 65 to 74 | 26 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 58 |
| Number Of Male Beneficiaries | 40 |
| Number Of Non Hispanic White Beneficiaries | 26 |
| Number Of Black or African American Beneficiaries | 72 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 22 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 76 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 17 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.2775 |