| National Provider Identifier [NPI]: | 1528056355 |
| Last Name Of The Provider | LEATHERLAND |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6920 ROANOKE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHAWSVILLE |
| Zip Code Of The Provider | 241620467 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 881 |
| Number Of Medicare Beneficiaries | 215 |
| Total Submitted Charge Amount | 61068 |
| Total Medicare Allowed Amount | 43582.64 |
| Total Medicare Payment Amount | 29578.41 |
| Total Medicare Standardized Payment Amount | 30514.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 134 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 3299 |
| Total Drug Medicare AllowedAmount | 1948.82 |
| Total Drug Medicare PaymentAmount | 1876.03 |
| Total Drug Medicare Standardized Payment Amount | 1876.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 747 |
| Number Of Medicare Beneficiaries With Medical Services | 215 |
| Total Medical Submitted Charge Amount | 57769 |
| Total Medical Medicare Allowed Amount | 41633.82 |
| Total Medical Medicare Payment Amount | 27702.38 |
| Total Medical Medicare Standardized Payment Amount | 28638.16 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 87 |
| Number Of Beneficiaries Age 75 to 84 | 44 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 138 |
| Number Of Male Beneficiaries | 77 |
| 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 | 168 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0497 |