| National Provider Identifier [NPI]: | 1932194750 |
| Last Name Of The Provider | LAKE |
| First Name Of The Provider | LIBBY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1400 29TH ST S |
| Street Address 2 Of The Provider | |
| City Of The Provider | GREAT FALLS |
| Zip Code Of The Provider | 594055353 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 1925 |
| Number Of Medicare Beneficiaries | 598 |
| Total Submitted Charge Amount | 145206.19 |
| Total Medicare Allowed Amount | 129041.62 |
| Total Medicare Payment Amount | 87407.52 |
| Total Medicare Standardized Payment Amount | 87770.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 26 |
| Number Of Drug Services | 324 |
| Number Of Medicare Beneficiaries With Drug Services | 93 |
| Total Drug Submitted ChargeAmount | 5521.37 |
| Total Drug Medicare AllowedAmount | 4604 |
| Total Drug Medicare PaymentAmount | 4399.04 |
| Total Drug Medicare Standardized Payment Amount | 4399.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 1601 |
| Number Of Medicare Beneficiaries With Medical Services | 596 |
| Total Medical Submitted Charge Amount | 139684.82 |
| Total Medical Medicare Allowed Amount | 124437.62 |
| Total Medical Medicare Payment Amount | 83008.48 |
| Total Medical Medicare Standardized Payment Amount | 83371.07 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 101 |
| Number Of Beneficiaries Age 65 to 74 | 264 |
| Number Of Beneficiaries Age 75 to 84 | 158 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 442 |
| Number Of Male Beneficiaries | 156 |
| Number Of Non Hispanic White Beneficiaries | 557 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 21 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 488 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 110 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9751 |