| National Provider Identifier [NPI]: | 1114296134 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | ANP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8101 CLEARVISTA PKWY |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462564696 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 1232 |
| Number Of Medicare Beneficiaries | 375 |
| Total Submitted Charge Amount | 92967 |
| Total Medicare Allowed Amount | 53417.95 |
| Total Medicare Payment Amount | 38862.29 |
| Total Medicare Standardized Payment Amount | 48823.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 293 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 10781 |
| Total Drug Medicare AllowedAmount | 5991.56 |
| Total Drug Medicare PaymentAmount | 5139.98 |
| Total Drug Medicare Standardized Payment Amount | 5139.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 939 |
| Number Of Medicare Beneficiaries With Medical Services | 374 |
| Total Medical Submitted Charge Amount | 82186 |
| Total Medical Medicare Allowed Amount | 47426.39 |
| Total Medical Medicare Payment Amount | 33722.31 |
| Total Medical Medicare Standardized Payment Amount | 43683.51 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 149 |
| Number Of Beneficiaries Age 75 to 84 | 119 |
| Number Of Beneficiaries Age Greater 84 | 59 |
| Number Of Female Beneficiaries | 249 |
| Number Of Male Beneficiaries | 126 |
| Number Of Non Hispanic White Beneficiaries | 291 |
| Number Of Black or African American Beneficiaries | 69 |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 332 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 43 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3878 |