| National Provider Identifier [NPI]: | 1962507061 |
| Last Name Of The Provider | MISSAK |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7680 AIRWAYS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTHAVEN |
| Zip Code Of The Provider | 386715304 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 8054 |
| Number Of Medicare Beneficiaries | 3724 |
| Total Submitted Charge Amount | 594569 |
| Total Medicare Allowed Amount | 143796.88 |
| Total Medicare Payment Amount | 99593.57 |
| Total Medicare Standardized Payment Amount | 108107.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 91 |
| Number Of Medicare Beneficiaries With Drug Services | 80 |
| Total Drug Submitted ChargeAmount | 3895 |
| Total Drug Medicare AllowedAmount | 724.92 |
| Total Drug Medicare PaymentAmount | 655.04 |
| Total Drug Medicare Standardized Payment Amount | 655.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 7963 |
| Number Of Medicare Beneficiaries With Medical Services | 3724 |
| Total Medical Submitted Charge Amount | 590674 |
| Total Medical Medicare Allowed Amount | 143071.96 |
| Total Medical Medicare Payment Amount | 98938.53 |
| Total Medical Medicare Standardized Payment Amount | 107452.93 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 706 |
| Number Of Beneficiaries Age 65 to 74 | 1425 |
| Number Of Beneficiaries Age 75 to 84 | 1121 |
| Number Of Beneficiaries Age Greater 84 | 472 |
| Number Of Female Beneficiaries | 2172 |
| Number Of Male Beneficiaries | 1552 |
| Number Of Non Hispanic White Beneficiaries | 2756 |
| Number Of Black or African American Beneficiaries | 920 |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2604 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1120 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.8644 |