| National Provider Identifier [NPI]: | 1861479651 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 820 ST. SEBASTIAN WAY |
| Street Address 2 Of The Provider | SUITE 8A |
| City Of The Provider | AUGUSTA |
| Zip Code Of The Provider | 309010000 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 18000 |
| Number Of Medicare Beneficiaries | 676 |
| Total Submitted Charge Amount | 843637.6 |
| Total Medicare Allowed Amount | 374693.8 |
| Total Medicare Payment Amount | 288138 |
| Total Medicare Standardized Payment Amount | 299157.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 14210 |
| Number Of Medicare Beneficiaries With Drug Services | 45 |
| Total Drug Submitted ChargeAmount | 88277.6 |
| Total Drug Medicare AllowedAmount | 27016.63 |
| Total Drug Medicare PaymentAmount | 20583.53 |
| Total Drug Medicare Standardized Payment Amount | 20583.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 3790 |
| Number Of Medicare Beneficiaries With Medical Services | 676 |
| Total Medical Submitted Charge Amount | 755360 |
| Total Medical Medicare Allowed Amount | 347677.17 |
| Total Medical Medicare Payment Amount | 267554.47 |
| Total Medical Medicare Standardized Payment Amount | 278573.49 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 188 |
| Number Of Beneficiaries Age 65 to 74 | 211 |
| Number Of Beneficiaries Age 75 to 84 | 212 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 352 |
| Number Of Male Beneficiaries | 324 |
| Number Of Non Hispanic White Beneficiaries | 348 |
| Number Of Black or African American Beneficiaries | 317 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 439 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 237 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 51 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 69 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 4.2274 |