| National Provider Identifier [NPI]: | 1538321971 |
| Last Name Of The Provider | BANCROFT |
| First Name Of The Provider | SARAH |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 600 LEGACY PLAZA EAST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LA PORTE |
| Zip Code Of The Provider | 463505268 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Sports Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 222 |
| Number Of Medicare Beneficiaries | 34 |
| Total Submitted Charge Amount | 30132 |
| Total Medicare Allowed Amount | 9987.32 |
| Total Medicare Payment Amount | 7477.01 |
| Total Medicare Standardized Payment Amount | 7682.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 75 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 3262 |
| Total Drug Medicare AllowedAmount | 1055.38 |
| Total Drug Medicare PaymentAmount | 827.49 |
| Total Drug Medicare Standardized Payment Amount | 827.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 147 |
| Number Of Medicare Beneficiaries With Medical Services | 34 |
| Total Medical Submitted Charge Amount | 26870 |
| Total Medical Medicare Allowed Amount | 8931.94 |
| Total Medical Medicare Payment Amount | 6649.52 |
| Total Medical Medicare Standardized Payment Amount | 6854.66 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 13 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | 34 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| 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 | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9307 |