| National Provider Identifier [NPI]: | 1659319515 |
| Last Name Of The Provider | ADKISON |
| First Name Of The Provider | SHANE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1399 COUNTRY CLUB RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | GULF BREEZE |
| Zip Code Of The Provider | 325633451 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 545 |
| Number Of Medicare Beneficiaries | 207 |
| Total Submitted Charge Amount | 108147.82 |
| Total Medicare Allowed Amount | 43944.93 |
| Total Medicare Payment Amount | 30716.17 |
| Total Medicare Standardized Payment Amount | 31131.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 23 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 555.45 |
| Total Drug Medicare AllowedAmount | 276.92 |
| Total Drug Medicare PaymentAmount | 271.4 |
| Total Drug Medicare Standardized Payment Amount | 271.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 522 |
| Number Of Medicare Beneficiaries With Medical Services | 207 |
| Total Medical Submitted Charge Amount | 107592.37 |
| Total Medical Medicare Allowed Amount | 43668.01 |
| Total Medical Medicare Payment Amount | 30444.77 |
| Total Medical Medicare Standardized Payment Amount | 30859.61 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 95 |
| Number Of Beneficiaries Age 75 to 84 | 46 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 112 |
| Number Of Male Beneficiaries | 95 |
| Number Of Non Hispanic White Beneficiaries | 182 |
| 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 | 155 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8679 |