| National Provider Identifier [NPI]: | 1104816602 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | A.R.N.P. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1118 W BROADWAY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MUSKOGEE |
| Zip Code Of The Provider | 744016246 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 843 |
| Number Of Medicare Beneficiaries | 141 |
| Total Submitted Charge Amount | 53337 |
| Total Medicare Allowed Amount | 38890.11 |
| Total Medicare Payment Amount | 24995.54 |
| Total Medicare Standardized Payment Amount | 33451.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 80 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 1925 |
| Total Drug Medicare AllowedAmount | 224.47 |
| Total Drug Medicare PaymentAmount | 182.12 |
| Total Drug Medicare Standardized Payment Amount | 182.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 763 |
| Number Of Medicare Beneficiaries With Medical Services | 141 |
| Total Medical Submitted Charge Amount | 51412 |
| Total Medical Medicare Allowed Amount | 38665.64 |
| Total Medical Medicare Payment Amount | 24813.42 |
| Total Medical Medicare Standardized Payment Amount | 33269.75 |
| Average Age Of Beneficiaries | 55 |
| Number Of Beneficiaries Age Less65 | 95 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 86 |
| Number Of Male Beneficiaries | 55 |
| Number Of Non Hispanic White Beneficiaries | 98 |
| Number Of Black or African American Beneficiaries | 24 |
| 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 | 24 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 117 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1024 |