| National Provider Identifier [NPI]: | 1053374199 |
| Last Name Of The Provider | SHAPICH |
| First Name Of The Provider | TARA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 141 MEDICAL PARK LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | BELLEFONTE |
| Zip Code Of The Provider | 168239112 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 271 |
| Number Of Medicare Beneficiaries | 163 |
| Total Submitted Charge Amount | 35391 |
| Total Medicare Allowed Amount | 17072.65 |
| Total Medicare Payment Amount | 12279 |
| Total Medicare Standardized Payment Amount | 15340.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 17 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 835 |
| Total Drug Medicare AllowedAmount | 258.84 |
| Total Drug Medicare PaymentAmount | 245.32 |
| Total Drug Medicare Standardized Payment Amount | 245.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 254 |
| Number Of Medicare Beneficiaries With Medical Services | 163 |
| Total Medical Submitted Charge Amount | 34556 |
| Total Medical Medicare Allowed Amount | 16813.81 |
| Total Medical Medicare Payment Amount | 12033.68 |
| Total Medical Medicare Standardized Payment Amount | 15094.91 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 36 |
| Number Of Beneficiaries Age 65 to 74 | 42 |
| Number Of Beneficiaries Age 75 to 84 | 53 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 103 |
| Number Of Male Beneficiaries | 60 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 118 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 45 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 21 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3969 |