| National Provider Identifier [NPI]: | 1780645408 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 300 MEDICAL PLZ |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKE ST LOUIS |
| Zip Code Of The Provider | 633671481 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 1509 |
| Number Of Medicare Beneficiaries | 401 |
| Total Submitted Charge Amount | 149290 |
| Total Medicare Allowed Amount | 115048.27 |
| Total Medicare Payment Amount | 85037.63 |
| Total Medicare Standardized Payment Amount | 86726.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 3009 |
| Total Drug Medicare AllowedAmount | 1711.03 |
| Total Drug Medicare PaymentAmount | 1673.69 |
| Total Drug Medicare Standardized Payment Amount | 1673.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 1475 |
| Number Of Medicare Beneficiaries With Medical Services | 401 |
| Total Medical Submitted Charge Amount | 146281 |
| Total Medical Medicare Allowed Amount | 113337.24 |
| Total Medical Medicare Payment Amount | 83363.94 |
| Total Medical Medicare Standardized Payment Amount | 85053.17 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 74 |
| Number Of Beneficiaries Age 65 to 74 | 181 |
| Number Of Beneficiaries Age 75 to 84 | 106 |
| Number Of Beneficiaries Age Greater 84 | 40 |
| Number Of Female Beneficiaries | 229 |
| Number Of Male Beneficiaries | 172 |
| Number Of Non Hispanic White Beneficiaries | 383 |
| 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 | 360 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.331 |