| National Provider Identifier [NPI]: | 1083633416 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | MOLLY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 601 MEDICAL TOWER |
| Street Address 2 Of The Provider | |
| City Of The Provider | NORFOLK |
| Zip Code Of The Provider | 23507 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 10436 |
| Number Of Medicare Beneficiaries | 4762 |
| Total Submitted Charge Amount | 1479158 |
| Total Medicare Allowed Amount | 675870.01 |
| Total Medicare Payment Amount | 498422.11 |
| Total Medicare Standardized Payment Amount | 507163.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 69 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 14136 |
| Total Drug Medicare AllowedAmount | 10819.69 |
| Total Drug Medicare PaymentAmount | 8131.07 |
| Total Drug Medicare Standardized Payment Amount | 8131.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 10367 |
| Number Of Medicare Beneficiaries With Medical Services | 4762 |
| Total Medical Submitted Charge Amount | 1465022 |
| Total Medical Medicare Allowed Amount | 665050.32 |
| Total Medical Medicare Payment Amount | 490291.04 |
| Total Medical Medicare Standardized Payment Amount | 499032.12 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 191 |
| Number Of Beneficiaries Age 65 to 74 | 2508 |
| Number Of Beneficiaries Age 75 to 84 | 1489 |
| Number Of Beneficiaries Age Greater 84 | 574 |
| Number Of Female Beneficiaries | 2369 |
| Number Of Male Beneficiaries | 2393 |
| Number Of Non Hispanic White Beneficiaries | 4446 |
| Number Of Black or African American Beneficiaries | 180 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 75 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4611 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 151 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9483 |