| National Provider Identifier [NPI]: | 1952312969 |
| Last Name Of The Provider | SHIELDS |
| First Name Of The Provider | SARA |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | FAMILY PRACTICE |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 26 QUEEN ST |
| Street Address 2 Of The Provider | MEDICAL |
| City Of The Provider | WORCESTER |
| Zip Code Of The Provider | 016102473 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 528 |
| Number Of Medicare Beneficiaries | 123 |
| Total Submitted Charge Amount | 10252.99 |
| Total Medicare Allowed Amount | 5924.92 |
| Total Medicare Payment Amount | 5308.31 |
| Total Medicare Standardized Payment Amount | 5340.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 67 |
| Number Of Medicare Beneficiaries With Drug Services | 47 |
| Total Drug Submitted ChargeAmount | 1253.49 |
| Total Drug Medicare AllowedAmount | 1082.08 |
| Total Drug Medicare PaymentAmount | 1007.36 |
| Total Drug Medicare Standardized Payment Amount | 1007.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 461 |
| Number Of Medicare Beneficiaries With Medical Services | 123 |
| Total Medical Submitted Charge Amount | 8999.5 |
| Total Medical Medicare Allowed Amount | 4842.84 |
| Total Medical Medicare Payment Amount | 4300.95 |
| Total Medical Medicare Standardized Payment Amount | 4333.35 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 74 |
| Number Of Beneficiaries Age 65 to 74 | 35 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 64 |
| Number Of Male Beneficiaries | 59 |
| Number Of Non Hispanic White Beneficiaries | 37 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 68 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 14 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 109 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 63 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0272 |