| National Provider Identifier [NPI]: | 1518925106 |
| Last Name Of The Provider | CORNWALL |
| First Name Of The Provider | SUZANNE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4545 POINT FOSDICK DR NW |
| Street Address 2 Of The Provider | STE 250 |
| City Of The Provider | GIG HARBOR |
| Zip Code Of The Provider | 983351700 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 537 |
| Number Of Medicare Beneficiaries | 172 |
| Total Submitted Charge Amount | 68099 |
| Total Medicare Allowed Amount | 33659.73 |
| Total Medicare Payment Amount | 22843.35 |
| Total Medicare Standardized Payment Amount | 23380.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 173 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 4955 |
| Total Drug Medicare AllowedAmount | 3481.48 |
| Total Drug Medicare PaymentAmount | 3061.37 |
| Total Drug Medicare Standardized Payment Amount | 3061.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 364 |
| Number Of Medicare Beneficiaries With Medical Services | 172 |
| Total Medical Submitted Charge Amount | 63144 |
| Total Medical Medicare Allowed Amount | 30178.25 |
| Total Medical Medicare Payment Amount | 19781.98 |
| Total Medical Medicare Standardized Payment Amount | 20319.59 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 97 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 161 |
| Number Of Male Beneficiaries | 11 |
| Number Of Non Hispanic White Beneficiaries | 158 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 158 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9646 |