| National Provider Identifier [NPI]: | 1275662595 |
| Last Name Of The Provider | LOGAN |
| First Name Of The Provider | ADRIENNE |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | LISW-CP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1033 EDGEFIELD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | GREENWOOD |
| Zip Code Of The Provider | 296463205 |
| State Code Of The Provider | SC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Licensed Clinical Social Worker |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 7 |
| Number Of Services | 517 |
| Number Of Medicare Beneficiaries | 69 |
| Total Submitted Charge Amount | 115504 |
| Total Medicare Allowed Amount | 35068.64 |
| Total Medicare Payment Amount | 24375.79 |
| Total Medicare Standardized Payment Amount | 27396.59 |
| 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 | 7 |
| Number Of Medical Services | 517 |
| Number Of Medicare Beneficiaries With Medical Services | 69 |
| Total Medical Submitted Charge Amount | 115504 |
| Total Medical Medicare Allowed Amount | 35068.64 |
| Total Medical Medicare Payment Amount | 24375.79 |
| Total Medical Medicare Standardized Payment Amount | 27396.59 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 52 |
| Number Of Male Beneficiaries | 17 |
| Number Of Non Hispanic White Beneficiaries | 54 |
| Number Of Black or African American Beneficiaries | 15 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 46 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| 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 | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0079 |