| National Provider Identifier [NPI]: | 1457640476 |
| Last Name Of The Provider | LOUCKS |
| First Name Of The Provider | AMANDA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1215 LEE ST |
| Street Address 2 Of The Provider | BOX 800729 |
| City Of The Provider | CHARLOTTESVILLE |
| Zip Code Of The Provider | 229080816 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 382 |
| Number Of Medicare Beneficiaries | 90 |
| Total Submitted Charge Amount | 25187.8 |
| Total Medicare Allowed Amount | 17616.93 |
| Total Medicare Payment Amount | 13930.61 |
| Total Medicare Standardized Payment Amount | 15096.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 28 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 805.53 |
| Total Drug Medicare AllowedAmount | 775.83 |
| Total Drug Medicare PaymentAmount | 760.23 |
| Total Drug Medicare Standardized Payment Amount | 760.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 354 |
| Number Of Medicare Beneficiaries With Medical Services | 89 |
| Total Medical Submitted Charge Amount | 24382.27 |
| Total Medical Medicare Allowed Amount | 16841.1 |
| Total Medical Medicare Payment Amount | 13170.38 |
| Total Medical Medicare Standardized Payment Amount | 14335.82 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 50 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 67 |
| Number Of Male Beneficiaries | 23 |
| 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 | 72 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| 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 | |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9531 |