| National Provider Identifier [NPI]: | 1467496646 |
| Last Name Of The Provider | HUMPHREY |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 319 S SILVER SPRINGS RD |
| Street Address 2 Of The Provider | STE C |
| City Of The Provider | CAPE GIRARDEAU |
| Zip Code Of The Provider | 637036308 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Plastic and Reconstructive Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 129 |
| Number Of Services | 1455 |
| Number Of Medicare Beneficiaries | 330 |
| Total Submitted Charge Amount | 449570 |
| Total Medicare Allowed Amount | 191702.55 |
| Total Medicare Payment Amount | 143554.85 |
| Total Medicare Standardized Payment Amount | 156307.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 146 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 17625 |
| Total Drug Medicare AllowedAmount | 15780.79 |
| Total Drug Medicare PaymentAmount | 12182.29 |
| Total Drug Medicare Standardized Payment Amount | 12182.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 127 |
| Number Of Medical Services | 1309 |
| Number Of Medicare Beneficiaries With Medical Services | 330 |
| Total Medical Submitted Charge Amount | 431945 |
| Total Medical Medicare Allowed Amount | 175921.76 |
| Total Medical Medicare Payment Amount | 131372.56 |
| Total Medical Medicare Standardized Payment Amount | 144125.7 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 126 |
| Number Of Beneficiaries Age 75 to 84 | 95 |
| Number Of Beneficiaries Age Greater 84 | 47 |
| Number Of Female Beneficiaries | 184 |
| Number Of Male Beneficiaries | 146 |
| 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 | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 259 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 71 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1968 |