| National Provider Identifier [NPI]: | 1457446247 |
| Last Name Of The Provider | STITLE |
| First Name Of The Provider | LAURA |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 53 SOUTH PARK BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | GREENWOOD |
| Zip Code Of The Provider | 46143 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 3100 |
| Number Of Medicare Beneficiaries | 549 |
| Total Submitted Charge Amount | 258232.62 |
| Total Medicare Allowed Amount | 201008.28 |
| Total Medicare Payment Amount | 144382.71 |
| Total Medicare Standardized Payment Amount | 148207.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 340 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 684.18 |
| Total Drug Medicare AllowedAmount | 602.31 |
| Total Drug Medicare PaymentAmount | 449.27 |
| Total Drug Medicare Standardized Payment Amount | 449.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 78 |
| Number Of Medical Services | 2760 |
| Number Of Medicare Beneficiaries With Medical Services | 549 |
| Total Medical Submitted Charge Amount | 257548.44 |
| Total Medical Medicare Allowed Amount | 200405.97 |
| Total Medical Medicare Payment Amount | 143933.44 |
| Total Medical Medicare Standardized Payment Amount | 147758.35 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 319 |
| Number Of Beneficiaries Age 75 to 84 | 146 |
| Number Of Beneficiaries Age Greater 84 | 64 |
| Number Of Female Beneficiaries | 390 |
| Number Of Male Beneficiaries | 159 |
| Number Of Non Hispanic White Beneficiaries | 534 |
| 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 | 528 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8868 |