| National Provider Identifier [NPI]: | 1447249131 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | Q |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 206 E ELM ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CALDWELL |
| Zip Code Of The Provider | 836054815 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 85 |
| Number Of Services | 2030 |
| Number Of Medicare Beneficiaries | 299 |
| Total Submitted Charge Amount | 173191.62 |
| Total Medicare Allowed Amount | 135014.2 |
| Total Medicare Payment Amount | 100942.57 |
| Total Medicare Standardized Payment Amount | 111378.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 1122 |
| Number Of Medicare Beneficiaries With Drug Services | 74 |
| Total Drug Submitted ChargeAmount | 16867.8 |
| Total Drug Medicare AllowedAmount | 10940.33 |
| Total Drug Medicare PaymentAmount | 8539.09 |
| Total Drug Medicare Standardized Payment Amount | 8539.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 81 |
| Number Of Medical Services | 908 |
| Number Of Medicare Beneficiaries With Medical Services | 299 |
| Total Medical Submitted Charge Amount | 156323.82 |
| Total Medical Medicare Allowed Amount | 124073.87 |
| Total Medical Medicare Payment Amount | 92403.48 |
| Total Medical Medicare Standardized Payment Amount | 102839.06 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 123 |
| Number Of Beneficiaries Age 75 to 84 | 81 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 195 |
| Number Of Male Beneficiaries | 104 |
| Number Of Non Hispanic White Beneficiaries | 273 |
| 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 | 238 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 65 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0697 |