| National Provider Identifier [NPI]: | 1588667810 |
| Last Name Of The Provider | SHOCK |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1300 W LODI AVE |
| Street Address 2 Of The Provider | STE W |
| City Of The Provider | LODI |
| Zip Code Of The Provider | 952423037 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 83 |
| Number Of Services | 4565 |
| Number Of Medicare Beneficiaries | 1074 |
| Total Submitted Charge Amount | 350926.87 |
| Total Medicare Allowed Amount | 300573.37 |
| Total Medicare Payment Amount | 217338.63 |
| Total Medicare Standardized Payment Amount | 212185.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 336 |
| Number Of Medicare Beneficiaries With Drug Services | 85 |
| Total Drug Submitted ChargeAmount | 434 |
| Total Drug Medicare AllowedAmount | 322.81 |
| Total Drug Medicare PaymentAmount | 239.93 |
| Total Drug Medicare Standardized Payment Amount | 239.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 81 |
| Number Of Medical Services | 4229 |
| Number Of Medicare Beneficiaries With Medical Services | 1074 |
| Total Medical Submitted Charge Amount | 350492.87 |
| Total Medical Medicare Allowed Amount | 300250.56 |
| Total Medical Medicare Payment Amount | 217098.7 |
| Total Medical Medicare Standardized Payment Amount | 211945.72 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 124 |
| Number Of Beneficiaries Age 65 to 74 | 343 |
| Number Of Beneficiaries Age 75 to 84 | 309 |
| Number Of Beneficiaries Age Greater 84 | 298 |
| Number Of Female Beneficiaries | 622 |
| Number Of Male Beneficiaries | 452 |
| Number Of Non Hispanic White Beneficiaries | 897 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 133 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 802 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 272 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4143 |