| National Provider Identifier [NPI]: | 1558339606 |
| Last Name Of The Provider | GLICK |
| First Name Of The Provider | LESLIE |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 606 WILSON CREEK RD |
| Street Address 2 Of The Provider | STE 420 |
| City Of The Provider | LAWRENCEBURG |
| Zip Code Of The Provider | 47025 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 1642 |
| Number Of Medicare Beneficiaries | 170 |
| Total Submitted Charge Amount | 91668.5 |
| Total Medicare Allowed Amount | 73805.41 |
| Total Medicare Payment Amount | 50098.2 |
| Total Medicare Standardized Payment Amount | 54998.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 411 |
| Number Of Medicare Beneficiaries With Drug Services | 93 |
| Total Drug Submitted ChargeAmount | 6027 |
| Total Drug Medicare AllowedAmount | 2264.43 |
| Total Drug Medicare PaymentAmount | 2040.14 |
| Total Drug Medicare Standardized Payment Amount | 2040.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 1231 |
| Number Of Medicare Beneficiaries With Medical Services | 169 |
| Total Medical Submitted Charge Amount | 85641.5 |
| Total Medical Medicare Allowed Amount | 71540.98 |
| Total Medical Medicare Payment Amount | 48058.06 |
| Total Medical Medicare Standardized Payment Amount | 52958.04 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 84 |
| Number Of Beneficiaries Age 75 to 84 | 36 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 106 |
| Number Of Male Beneficiaries | 64 |
| 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 | 140 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 30 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9695 |