| National Provider Identifier [NPI]: | 1619969110 |
| Last Name Of The Provider | RICHARDSON |
| First Name Of The Provider | MONIQUE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 32730 WALKER RD |
| Street Address 2 Of The Provider | BUILDING H |
| City Of The Provider | AVON LAKE |
| Zip Code Of The Provider | 440124100 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 1020 |
| Number Of Medicare Beneficiaries | 349 |
| Total Submitted Charge Amount | 123797 |
| Total Medicare Allowed Amount | 74692.24 |
| Total Medicare Payment Amount | 53752.09 |
| Total Medicare Standardized Payment Amount | 55705.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 80 |
| Number Of Medicare Beneficiaries With Drug Services | 47 |
| Total Drug Submitted ChargeAmount | 3473 |
| Total Drug Medicare AllowedAmount | 2584.36 |
| Total Drug Medicare PaymentAmount | 2432.65 |
| Total Drug Medicare Standardized Payment Amount | 2432.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 940 |
| Number Of Medicare Beneficiaries With Medical Services | 349 |
| Total Medical Submitted Charge Amount | 120324 |
| Total Medical Medicare Allowed Amount | 72107.88 |
| Total Medical Medicare Payment Amount | 51319.44 |
| Total Medical Medicare Standardized Payment Amount | 53273.04 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 109 |
| Number Of Beneficiaries Age 75 to 84 | 94 |
| Number Of Beneficiaries Age Greater 84 | 117 |
| Number Of Female Beneficiaries | 249 |
| Number Of Male Beneficiaries | 100 |
| Number Of Non Hispanic White Beneficiaries | 331 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 299 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 50 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.472 |