| National Provider Identifier [NPI]: | 1497808927 |
| Last Name Of The Provider | LEVY |
| First Name Of The Provider | STEPHANIE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 480 4TH AVE STE 307 |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHULA VISTA |
| Zip Code Of The Provider | 919104403 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 454 |
| Number Of Medicare Beneficiaries | 65 |
| Total Submitted Charge Amount | 80675 |
| Total Medicare Allowed Amount | 27475.99 |
| Total Medicare Payment Amount | 21401.3 |
| Total Medicare Standardized Payment Amount | 23256.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 112 |
| Number Of Medicare Beneficiaries With Drug Services | 56 |
| Total Drug Submitted ChargeAmount | 18421 |
| Total Drug Medicare AllowedAmount | 6628.72 |
| Total Drug Medicare PaymentAmount | 5056.84 |
| Total Drug Medicare Standardized Payment Amount | 5056.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 342 |
| Number Of Medicare Beneficiaries With Medical Services | 65 |
| Total Medical Submitted Charge Amount | 62254 |
| Total Medical Medicare Allowed Amount | 20847.27 |
| Total Medical Medicare Payment Amount | 16344.46 |
| Total Medical Medicare Standardized Payment Amount | 18199.45 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 25 |
| Number Of Beneficiaries Age 75 to 84 | 20 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 48 |
| Number Of Male Beneficiaries | 17 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 42 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 21 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 44 |
| 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 | 28 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4326 |