| National Provider Identifier [NPI]: | 1194788703 |
| Last Name Of The Provider | FREDERICK |
| First Name Of The Provider | SHIRLEY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 31 COLCORD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTH BERWICK |
| Zip Code Of The Provider | 039081004 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 1290 |
| Number Of Medicare Beneficiaries | 314 |
| Total Submitted Charge Amount | 218788 |
| Total Medicare Allowed Amount | 99479.93 |
| Total Medicare Payment Amount | 73799.77 |
| Total Medicare Standardized Payment Amount | 76051.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 116 |
| Number Of Medicare Beneficiaries With Drug Services | 102 |
| Total Drug Submitted ChargeAmount | 3060 |
| Total Drug Medicare AllowedAmount | 2770.12 |
| Total Drug Medicare PaymentAmount | 2701.49 |
| Total Drug Medicare Standardized Payment Amount | 2701.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 1174 |
| Number Of Medicare Beneficiaries With Medical Services | 314 |
| Total Medical Submitted Charge Amount | 215728 |
| Total Medical Medicare Allowed Amount | 96709.81 |
| Total Medical Medicare Payment Amount | 71098.28 |
| Total Medical Medicare Standardized Payment Amount | 73350.44 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 65 |
| Number Of Beneficiaries Age 65 to 74 | 135 |
| Number Of Beneficiaries Age 75 to 84 | 70 |
| Number Of Beneficiaries Age Greater 84 | 44 |
| Number Of Female Beneficiaries | 243 |
| Number Of Male Beneficiaries | 71 |
| 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 | 224 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 90 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 54 |
| 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 | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0278 |