| National Provider Identifier [NPI]: | 1902119290 |
| Last Name Of The Provider | PENDERGRASS |
| First Name Of The Provider | STEPHANIE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3800 S. NATIONAL AVE |
| Street Address 2 Of The Provider | #600 |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 658075249 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 501 |
| Number Of Medicare Beneficiaries | 162 |
| Total Submitted Charge Amount | 54112 |
| Total Medicare Allowed Amount | 31724.1 |
| Total Medicare Payment Amount | 22190.82 |
| Total Medicare Standardized Payment Amount | 24199.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 51 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 1036 |
| Total Drug Medicare AllowedAmount | 807.68 |
| Total Drug Medicare PaymentAmount | 776.7 |
| Total Drug Medicare Standardized Payment Amount | 776.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 450 |
| Number Of Medicare Beneficiaries With Medical Services | 162 |
| Total Medical Submitted Charge Amount | 53076 |
| Total Medical Medicare Allowed Amount | 30916.42 |
| Total Medical Medicare Payment Amount | 21414.12 |
| Total Medical Medicare Standardized Payment Amount | 23422.58 |
| Average Age Of Beneficiaries | 60 |
| Number Of Beneficiaries Age Less65 | 91 |
| Number Of Beneficiaries Age 65 to 74 | 47 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 107 |
| Number Of Male Beneficiaries | 55 |
| 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 | 76 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 86 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 49 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3066 |