| National Provider Identifier [NPI]: | 1346446499 |
| Last Name Of The Provider | ROSS |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 64 BUSINESS CENTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | PAWLEYS ISLAND |
| Zip Code Of The Provider | 295857963 |
| State Code Of The Provider | SC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pediatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 3600 |
| Number Of Medicare Beneficiaries | 1054 |
| Total Submitted Charge Amount | 303033.31 |
| Total Medicare Allowed Amount | 172021.47 |
| Total Medicare Payment Amount | 131221.98 |
| Total Medicare Standardized Payment Amount | 138733.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 232 |
| Number Of Medicare Beneficiaries With Drug Services | 196 |
| Total Drug Submitted ChargeAmount | 13487 |
| Total Drug Medicare AllowedAmount | 11270.6 |
| Total Drug Medicare PaymentAmount | 11022.43 |
| Total Drug Medicare Standardized Payment Amount | 11022.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 3368 |
| Number Of Medicare Beneficiaries With Medical Services | 1054 |
| Total Medical Submitted Charge Amount | 289546.31 |
| Total Medical Medicare Allowed Amount | 160750.87 |
| Total Medical Medicare Payment Amount | 120199.55 |
| Total Medical Medicare Standardized Payment Amount | 127710.99 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 115 |
| Number Of Beneficiaries Age 65 to 74 | 460 |
| Number Of Beneficiaries Age 75 to 84 | 339 |
| Number Of Beneficiaries Age Greater 84 | 140 |
| Number Of Female Beneficiaries | 614 |
| Number Of Male Beneficiaries | 440 |
| Number Of Non Hispanic White Beneficiaries | 898 |
| Number Of Black or African American Beneficiaries | 137 |
| 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 | 916 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 138 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.3929 |