| National Provider Identifier [NPI]: | 1346225919 |
| Last Name Of The Provider | STOREY |
| First Name Of The Provider | SUZANNE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 611 E VILLANOW ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LA FAYETTE |
| Zip Code Of The Provider | 307282618 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 127 |
| Number Of Services | 7088 |
| Number Of Medicare Beneficiaries | 535 |
| Total Submitted Charge Amount | 441372 |
| Total Medicare Allowed Amount | 186118.42 |
| Total Medicare Payment Amount | 138799.28 |
| Total Medicare Standardized Payment Amount | 148383.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 18 |
| Number Of Drug Services | 940 |
| Number Of Medicare Beneficiaries With Drug Services | 221 |
| Total Drug Submitted ChargeAmount | 19299 |
| Total Drug Medicare AllowedAmount | 5925.98 |
| Total Drug Medicare PaymentAmount | 5306.81 |
| Total Drug Medicare Standardized Payment Amount | 5306.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 109 |
| Number Of Medical Services | 6148 |
| Number Of Medicare Beneficiaries With Medical Services | 535 |
| Total Medical Submitted Charge Amount | 422073 |
| Total Medical Medicare Allowed Amount | 180192.44 |
| Total Medical Medicare Payment Amount | 133492.47 |
| Total Medical Medicare Standardized Payment Amount | 143077.17 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 154 |
| Number Of Beneficiaries Age 65 to 74 | 206 |
| Number Of Beneficiaries Age 75 to 84 | 132 |
| Number Of Beneficiaries Age Greater 84 | 43 |
| Number Of Female Beneficiaries | 392 |
| Number Of Male Beneficiaries | 143 |
| Number Of Non Hispanic White Beneficiaries | 516 |
| 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 | 404 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 131 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0893 |