| National Provider Identifier [NPI]: | 1609885813 |
| Last Name Of The Provider | MIZE |
| First Name Of The Provider | SHANNON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 208 HUDSON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CUMMING |
| Zip Code Of The Provider | 300402432 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 1325 |
| Number Of Medicare Beneficiaries | 229 |
| Total Submitted Charge Amount | 84936.76 |
| Total Medicare Allowed Amount | 70649.72 |
| Total Medicare Payment Amount | 52237.42 |
| Total Medicare Standardized Payment Amount | 55415.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 807.09 |
| Total Drug Medicare AllowedAmount | 635.01 |
| Total Drug Medicare PaymentAmount | 622.35 |
| Total Drug Medicare Standardized Payment Amount | 622.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 1289 |
| Number Of Medicare Beneficiaries With Medical Services | 229 |
| Total Medical Submitted Charge Amount | 84129.67 |
| Total Medical Medicare Allowed Amount | 70014.71 |
| Total Medical Medicare Payment Amount | 51615.07 |
| Total Medical Medicare Standardized Payment Amount | 54792.98 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 142 |
| Number Of Beneficiaries Age 75 to 84 | 51 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 124 |
| Number Of Male Beneficiaries | 105 |
| 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 | 215 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.0457 |