| National Provider Identifier [NPI]: | 1902889868 |
| Last Name Of The Provider | SHATTUCK |
| First Name Of The Provider | MARCIA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 416 CONNABLE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PETOSKEY |
| Zip Code Of The Provider | 497702212 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 4336 |
| Number Of Medicare Beneficiaries | 1701 |
| Total Submitted Charge Amount | 664217 |
| Total Medicare Allowed Amount | 140538.97 |
| Total Medicare Payment Amount | 108659.22 |
| Total Medicare Standardized Payment Amount | 86957.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 4336 |
| Number Of Medicare Beneficiaries With Medical Services | 1701 |
| Total Medical Submitted Charge Amount | 664217 |
| Total Medical Medicare Allowed Amount | 140538.97 |
| Total Medical Medicare Payment Amount | 108659.22 |
| Total Medical Medicare Standardized Payment Amount | 86957.1 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 289 |
| Number Of Beneficiaries Age 65 to 74 | 750 |
| Number Of Beneficiaries Age 75 to 84 | 496 |
| Number Of Beneficiaries Age Greater 84 | 166 |
| Number Of Female Beneficiaries | 838 |
| Number Of Male Beneficiaries | 863 |
| Number Of Non Hispanic White Beneficiaries | 1624 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 43 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1400 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 301 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1807 |