| National Provider Identifier [NPI]: | 1003926049 |
| Last Name Of The Provider | WATSON |
| First Name Of The Provider | STACEY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8450 N 32ND ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | RICHLAND |
| Zip Code Of The Provider | 490839418 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 4189 |
| Number Of Medicare Beneficiaries | 2061 |
| Total Submitted Charge Amount | 198939 |
| Total Medicare Allowed Amount | 110577.39 |
| Total Medicare Payment Amount | 103534.4 |
| Total Medicare Standardized Payment Amount | 106723.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 1992 |
| Number Of Medicare Beneficiaries With Drug Services | 1962 |
| Total Drug Submitted ChargeAmount | 103446 |
| Total Drug Medicare AllowedAmount | 47873.43 |
| Total Drug Medicare PaymentAmount | 46912.96 |
| Total Drug Medicare Standardized Payment Amount | 46912.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 2197 |
| Number Of Medicare Beneficiaries With Medical Services | 2057 |
| Total Medical Submitted Charge Amount | 95493 |
| Total Medical Medicare Allowed Amount | 62703.96 |
| Total Medical Medicare Payment Amount | 56621.44 |
| Total Medical Medicare Standardized Payment Amount | 59810.7 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 77 |
| Number Of Beneficiaries Age 65 to 74 | 590 |
| Number Of Beneficiaries Age 75 to 84 | 754 |
| Number Of Beneficiaries Age Greater 84 | 640 |
| Number Of Female Beneficiaries | 1337 |
| Number Of Male Beneficiaries | 724 |
| Number Of Non Hispanic White Beneficiaries | 1978 |
| Number Of Black or African American Beneficiaries | 39 |
| 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 | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1892 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 169 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0168 |