| National Provider Identifier [NPI]: | 1487677381 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | STANLEY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8510 NORTH 123RD EAST AVENUE |
| Street Address 2 Of The Provider | |
| City Of The Provider | OWASSO |
| Zip Code Of The Provider | 74055 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 158 |
| Number Of Services | 5384 |
| Number Of Medicare Beneficiaries | 583 |
| Total Submitted Charge Amount | 330223.26 |
| Total Medicare Allowed Amount | 122128.14 |
| Total Medicare Payment Amount | 89853.61 |
| Total Medicare Standardized Payment Amount | 96938.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 1036 |
| Number Of Medicare Beneficiaries With Drug Services | 176 |
| Total Drug Submitted ChargeAmount | 12547.53 |
| Total Drug Medicare AllowedAmount | 4234.79 |
| Total Drug Medicare PaymentAmount | 3408.97 |
| Total Drug Medicare Standardized Payment Amount | 3408.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 142 |
| Number Of Medical Services | 4348 |
| Number Of Medicare Beneficiaries With Medical Services | 581 |
| Total Medical Submitted Charge Amount | 317675.73 |
| Total Medical Medicare Allowed Amount | 117893.35 |
| Total Medical Medicare Payment Amount | 86444.64 |
| Total Medical Medicare Standardized Payment Amount | 93529.68 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 119 |
| Number Of Beneficiaries Age 65 to 74 | 281 |
| Number Of Beneficiaries Age 75 to 84 | 132 |
| Number Of Beneficiaries Age Greater 84 | 51 |
| Number Of Female Beneficiaries | 321 |
| Number Of Male Beneficiaries | 262 |
| Number Of Non Hispanic White Beneficiaries | 302 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 270 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 443 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 140 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1872 |