| National Provider Identifier [NPI]: | 1063486280 |
| Last Name Of The Provider | KECK-SMITH |
| First Name Of The Provider | TANYA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5031 SW 29TH STREET |
| Street Address 2 Of The Provider | ACCESS MEDICAL CENTER |
| City Of The Provider | OKLAHOMA CITY |
| Zip Code Of The Provider | 73179 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 435 |
| Number Of Medicare Beneficiaries | 189 |
| Total Submitted Charge Amount | 35124.41 |
| Total Medicare Allowed Amount | 18829.55 |
| Total Medicare Payment Amount | 13668.65 |
| Total Medicare Standardized Payment Amount | 17693.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 61 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 730.93 |
| Total Drug Medicare AllowedAmount | 98.78 |
| Total Drug Medicare PaymentAmount | 75.26 |
| Total Drug Medicare Standardized Payment Amount | 75.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 374 |
| Number Of Medicare Beneficiaries With Medical Services | 189 |
| Total Medical Submitted Charge Amount | 34393.48 |
| Total Medical Medicare Allowed Amount | 18730.77 |
| Total Medical Medicare Payment Amount | 13593.39 |
| Total Medical Medicare Standardized Payment Amount | 17618.4 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 99 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 132 |
| Number Of Male Beneficiaries | 57 |
| Number Of Non Hispanic White Beneficiaries | 168 |
| 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 | 167 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.802 |