| National Provider Identifier [NPI]: | 1134117898 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | SHONDRA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3635 NELSON ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKE CHARLES |
| Zip Code Of The Provider | 706050000 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 2914 |
| Number Of Medicare Beneficiaries | 652 |
| Total Submitted Charge Amount | 441956 |
| Total Medicare Allowed Amount | 172736.49 |
| Total Medicare Payment Amount | 119638.49 |
| Total Medicare Standardized Payment Amount | 132895.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 25 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 625 |
| Total Drug Medicare AllowedAmount | 44.52 |
| Total Drug Medicare PaymentAmount | 33.49 |
| Total Drug Medicare Standardized Payment Amount | 33.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 2889 |
| Number Of Medicare Beneficiaries With Medical Services | 652 |
| Total Medical Submitted Charge Amount | 441331 |
| Total Medical Medicare Allowed Amount | 172691.97 |
| Total Medical Medicare Payment Amount | 119605 |
| Total Medical Medicare Standardized Payment Amount | 132862.15 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 356 |
| Number Of Beneficiaries Age 75 to 84 | 208 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 333 |
| Number Of Male Beneficiaries | 319 |
| Number Of Non Hispanic White Beneficiaries | 594 |
| Number Of Black or African American Beneficiaries | 42 |
| 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 | 606 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 46 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.893 |