| National Provider Identifier [NPI]: | 1316258874 |
| Last Name Of The Provider | BUSH |
| First Name Of The Provider | SHANE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3630 WILLOWCREEK RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORTAGE |
| Zip Code Of The Provider | 463685075 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 1375 |
| Number Of Medicare Beneficiaries | 374 |
| Total Submitted Charge Amount | 216011 |
| Total Medicare Allowed Amount | 95809.75 |
| Total Medicare Payment Amount | 58209.48 |
| Total Medicare Standardized Payment Amount | 63451.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 104 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 3235 |
| Total Drug Medicare AllowedAmount | 757.61 |
| Total Drug Medicare PaymentAmount | 643 |
| Total Drug Medicare Standardized Payment Amount | 643 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 1271 |
| Number Of Medicare Beneficiaries With Medical Services | 374 |
| Total Medical Submitted Charge Amount | 212776 |
| Total Medical Medicare Allowed Amount | 95052.14 |
| Total Medical Medicare Payment Amount | 57566.48 |
| Total Medical Medicare Standardized Payment Amount | 62808.76 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 172 |
| Number Of Beneficiaries Age 75 to 84 | 109 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 160 |
| Number Of Male Beneficiaries | 214 |
| Number Of Non Hispanic White Beneficiaries | 341 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 326 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 48 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.063 |