| National Provider Identifier [NPI]: | 1598758500 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | HEATHER |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2003 STULTS RD |
| Street Address 2 Of The Provider | #210 |
| City Of The Provider | HUNTINGTON |
| Zip Code Of The Provider | 467501291 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 661 |
| Number Of Medicare Beneficiaries | 156 |
| Total Submitted Charge Amount | 227189 |
| Total Medicare Allowed Amount | 30487.85 |
| Total Medicare Payment Amount | 21883.41 |
| Total Medicare Standardized Payment Amount | 26118.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 183 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 19372 |
| Total Drug Medicare AllowedAmount | 5222.39 |
| Total Drug Medicare PaymentAmount | 4000.23 |
| Total Drug Medicare Standardized Payment Amount | 4000.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 478 |
| Number Of Medicare Beneficiaries With Medical Services | 156 |
| Total Medical Submitted Charge Amount | 207817 |
| Total Medical Medicare Allowed Amount | 25265.46 |
| Total Medical Medicare Payment Amount | 17883.18 |
| Total Medical Medicare Standardized Payment Amount | 22118.76 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 55 |
| Number Of Beneficiaries Age 75 to 84 | 39 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 106 |
| Number Of Male Beneficiaries | 50 |
| 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 | 119 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 69 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0782 |