| National Provider Identifier [NPI]: | 1962451518 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 376A SIMPSON HIGHWAY 149 |
| Street Address 2 Of The Provider | |
| City Of The Provider | MAGEE |
| Zip Code Of The Provider | 391113409 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 89 |
| Number Of Services | 6523 |
| Number Of Medicare Beneficiaries | 814 |
| Total Submitted Charge Amount | 374585.75 |
| Total Medicare Allowed Amount | 207168.85 |
| Total Medicare Payment Amount | 150724.96 |
| Total Medicare Standardized Payment Amount | 156631.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 1614 |
| Number Of Medicare Beneficiaries With Drug Services | 282 |
| Total Drug Submitted ChargeAmount | 20868.75 |
| Total Drug Medicare AllowedAmount | 6352.5 |
| Total Drug Medicare PaymentAmount | 5302.23 |
| Total Drug Medicare Standardized Payment Amount | 5302.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 75 |
| Number Of Medical Services | 4909 |
| Number Of Medicare Beneficiaries With Medical Services | 814 |
| Total Medical Submitted Charge Amount | 353717 |
| Total Medical Medicare Allowed Amount | 200816.35 |
| Total Medical Medicare Payment Amount | 145422.73 |
| Total Medical Medicare Standardized Payment Amount | 151328.92 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 184 |
| Number Of Beneficiaries Age 65 to 74 | 309 |
| Number Of Beneficiaries Age 75 to 84 | 223 |
| Number Of Beneficiaries Age Greater 84 | 98 |
| Number Of Female Beneficiaries | 556 |
| Number Of Male Beneficiaries | 258 |
| Number Of Non Hispanic White Beneficiaries | 592 |
| 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 | 469 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 345 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2498 |