| National Provider Identifier [NPI]: | 1912088147 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 809 W HARWOOD RD |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | HURST |
| Zip Code Of The Provider | 760543289 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 554 |
| Number Of Medicare Beneficiaries | 92 |
| Total Submitted Charge Amount | 166881 |
| Total Medicare Allowed Amount | 22839.11 |
| Total Medicare Payment Amount | 17645.88 |
| Total Medicare Standardized Payment Amount | 19338.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 276 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 9120 |
| Total Drug Medicare AllowedAmount | 3045.46 |
| Total Drug Medicare PaymentAmount | 2387.68 |
| Total Drug Medicare Standardized Payment Amount | 2387.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 278 |
| Number Of Medicare Beneficiaries With Medical Services | 92 |
| Total Medical Submitted Charge Amount | 157761 |
| Total Medical Medicare Allowed Amount | 19793.65 |
| Total Medical Medicare Payment Amount | 15258.2 |
| Total Medical Medicare Standardized Payment Amount | 16950.34 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 52 |
| Number Of Beneficiaries Age 75 to 84 | 23 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 49 |
| Number Of Male Beneficiaries | 43 |
| Number Of Non Hispanic White Beneficiaries | 75 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1504 |