| National Provider Identifier [NPI]: | 1538133871 |
| Last Name Of The Provider | SHEBA |
| First Name Of The Provider | STACI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 25 MAIN STREET |
| Street Address 2 Of The Provider | |
| City Of The Provider | SMITHFIELD |
| Zip Code Of The Provider | 15478 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 1316 |
| Number Of Medicare Beneficiaries | 284 |
| Total Submitted Charge Amount | 103305 |
| Total Medicare Allowed Amount | 68488.95 |
| Total Medicare Payment Amount | 45004.47 |
| Total Medicare Standardized Payment Amount | 47310.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 128 |
| Number Of Medicare Beneficiaries With Drug Services | 115 |
| Total Drug Submitted ChargeAmount | 6110 |
| Total Drug Medicare AllowedAmount | 4042.72 |
| Total Drug Medicare PaymentAmount | 3954.62 |
| Total Drug Medicare Standardized Payment Amount | 3954.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 1188 |
| Number Of Medicare Beneficiaries With Medical Services | 284 |
| Total Medical Submitted Charge Amount | 97195 |
| Total Medical Medicare Allowed Amount | 64446.23 |
| Total Medical Medicare Payment Amount | 41049.85 |
| Total Medical Medicare Standardized Payment Amount | 43355.85 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 72 |
| Number Of Beneficiaries Age 65 to 74 | 104 |
| Number Of Beneficiaries Age 75 to 84 | 70 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 187 |
| Number Of Male Beneficiaries | 97 |
| 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 | 178 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 106 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0055 |