| National Provider Identifier [NPI]: | 1154374932 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4301 W. MARKHAM ST |
| Street Address 2 Of The Provider | #783 |
| City Of The Provider | LITTLE ROCK |
| Zip Code Of The Provider | 72205 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 825 |
| Number Of Medicare Beneficiaries | 168 |
| Total Submitted Charge Amount | 70921 |
| Total Medicare Allowed Amount | 37486.48 |
| Total Medicare Payment Amount | 26100.6 |
| Total Medicare Standardized Payment Amount | 29401.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 46 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 1975 |
| Total Drug Medicare AllowedAmount | 1267.35 |
| Total Drug Medicare PaymentAmount | 1225.56 |
| Total Drug Medicare Standardized Payment Amount | 1225.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 779 |
| Number Of Medicare Beneficiaries With Medical Services | 168 |
| Total Medical Submitted Charge Amount | 68946 |
| Total Medical Medicare Allowed Amount | 36219.13 |
| Total Medical Medicare Payment Amount | 24875.04 |
| Total Medical Medicare Standardized Payment Amount | 28175.6 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 75 |
| Number Of Beneficiaries Age 65 to 74 | 55 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 68 |
| Number Of Non Hispanic White Beneficiaries | 99 |
| 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 | 100 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5327 |