| National Provider Identifier [NPI]: | 1003846833 |
| Last Name Of The Provider | SOMERVELL |
| First Name Of The Provider | PAMELA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 714 N MICHIGAN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTH BEND |
| Zip Code Of The Provider | 466011035 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 69 |
| Number Of Services | 2862 |
| Number Of Medicare Beneficiaries | 254 |
| Total Submitted Charge Amount | 176488.25 |
| Total Medicare Allowed Amount | 99646.71 |
| Total Medicare Payment Amount | 75627.47 |
| Total Medicare Standardized Payment Amount | 76720.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 627 |
| Number Of Medicare Beneficiaries With Drug Services | 138 |
| Total Drug Submitted ChargeAmount | 13279.25 |
| Total Drug Medicare AllowedAmount | 8521.66 |
| Total Drug Medicare PaymentAmount | 8302.46 |
| Total Drug Medicare Standardized Payment Amount | 8302.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 2235 |
| Number Of Medicare Beneficiaries With Medical Services | 254 |
| Total Medical Submitted Charge Amount | 163209 |
| Total Medical Medicare Allowed Amount | 91125.05 |
| Total Medical Medicare Payment Amount | 67325.01 |
| Total Medical Medicare Standardized Payment Amount | 68417.93 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 103 |
| Number Of Beneficiaries Age 65 to 74 | 82 |
| Number Of Beneficiaries Age 75 to 84 | 51 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 171 |
| Number Of Male Beneficiaries | 83 |
| Number Of Non Hispanic White Beneficiaries | 238 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 147 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 107 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1763 |