| National Provider Identifier [NPI]: | 1700877537 |
| Last Name Of The Provider | TAH-CLAYTON |
| First Name Of The Provider | BRIDGET |
| Middle Initial Of The Provider | Y |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 701 SOUTH 28TH AVENUE |
| Street Address 2 Of The Provider | SUITE D |
| City Of The Provider | HATTIESBURG |
| Zip Code Of The Provider | 39401 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 3367 |
| Number Of Medicare Beneficiaries | 1523 |
| Total Submitted Charge Amount | 243959.55 |
| Total Medicare Allowed Amount | 132258.6 |
| Total Medicare Payment Amount | 91674.09 |
| Total Medicare Standardized Payment Amount | 101669.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 268 |
| Number Of Medicare Beneficiaries With Drug Services | 144 |
| Total Drug Submitted ChargeAmount | 9665 |
| Total Drug Medicare AllowedAmount | 3455.14 |
| Total Drug Medicare PaymentAmount | 3289.95 |
| Total Drug Medicare Standardized Payment Amount | 3289.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 3099 |
| Number Of Medicare Beneficiaries With Medical Services | 1523 |
| Total Medical Submitted Charge Amount | 234294.55 |
| Total Medical Medicare Allowed Amount | 128803.46 |
| Total Medical Medicare Payment Amount | 88384.14 |
| Total Medical Medicare Standardized Payment Amount | 98379.77 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 431 |
| Number Of Beneficiaries Age 65 to 74 | 587 |
| Number Of Beneficiaries Age 75 to 84 | 361 |
| Number Of Beneficiaries Age Greater 84 | 144 |
| Number Of Female Beneficiaries | 856 |
| Number Of Male Beneficiaries | 667 |
| Number Of Non Hispanic White Beneficiaries | 966 |
| Number Of Black or African American Beneficiaries | 538 |
| 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 | 878 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 645 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.8017 |