| National Provider Identifier [NPI]: | 1346345154 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | BOWDOIN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9 MAGGART CIR |
| Street Address 2 Of The Provider | |
| City Of The Provider | CARTHAGE |
| Zip Code Of The Provider | 370302151 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 77 |
| Number Of Services | 11873 |
| Number Of Medicare Beneficiaries | 235 |
| Total Submitted Charge Amount | 729756 |
| Total Medicare Allowed Amount | 259256.79 |
| Total Medicare Payment Amount | 194083.96 |
| Total Medicare Standardized Payment Amount | 195854.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 6066 |
| Number Of Medicare Beneficiaries With Drug Services | 192 |
| Total Drug Submitted ChargeAmount | 122314 |
| Total Drug Medicare AllowedAmount | 24869.05 |
| Total Drug Medicare PaymentAmount | 18510.45 |
| Total Drug Medicare Standardized Payment Amount | 18510.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 66 |
| Number Of Medical Services | 5807 |
| Number Of Medicare Beneficiaries With Medical Services | 235 |
| Total Medical Submitted Charge Amount | 607442 |
| Total Medical Medicare Allowed Amount | 234387.74 |
| Total Medical Medicare Payment Amount | 175573.51 |
| Total Medical Medicare Standardized Payment Amount | 177344.36 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 94 |
| Number Of Beneficiaries Age 65 to 74 | 94 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 115 |
| Number Of Male Beneficiaries | 120 |
| 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 | 127 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 108 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4115 |