| National Provider Identifier [NPI]: | 1609827187 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | SHANNON |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | PHYSICIAN ASSISTANT |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 18300 ROSCOE BLVD |
| Street Address 2 Of The Provider | NORTHRIDGE HOSPITAL MEDICAL CENTER |
| City Of The Provider | NORTHRIDGE |
| Zip Code Of The Provider | 91326 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 221 |
| Number Of Medicare Beneficiaries | 149 |
| Total Submitted Charge Amount | 105383 |
| Total Medicare Allowed Amount | 17342.53 |
| Total Medicare Payment Amount | 12850.58 |
| Total Medicare Standardized Payment Amount | 14566.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 221 |
| Number Of Medicare Beneficiaries With Medical Services | 149 |
| Total Medical Submitted Charge Amount | 105383 |
| Total Medical Medicare Allowed Amount | 17342.53 |
| Total Medical Medicare Payment Amount | 12850.58 |
| Total Medical Medicare Standardized Payment Amount | 14566.07 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 77 |
| Number Of Beneficiaries Age 65 to 74 | 35 |
| Number Of Beneficiaries Age 75 to 84 | 20 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 97 |
| Number Of Male Beneficiaries | 52 |
| Number Of Non Hispanic White Beneficiaries | 85 |
| Number Of Black or African American Beneficiaries | 11 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 45 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 104 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 23 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.7553 |