| National Provider Identifier [NPI]: | 1023007168 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | DENISE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2323 W ROSE GARDEN LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHOENIX |
| Zip Code Of The Provider | 850272530 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 144 |
| Number Of Services | 13563 |
| Number Of Medicare Beneficiaries | 1826 |
| Total Submitted Charge Amount | 957341.4 |
| Total Medicare Allowed Amount | 277268.81 |
| Total Medicare Payment Amount | 215714.84 |
| Total Medicare Standardized Payment Amount | 222283.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 9839 |
| Number Of Medicare Beneficiaries With Drug Services | 132 |
| Total Drug Submitted ChargeAmount | 20185.4 |
| Total Drug Medicare AllowedAmount | 2031.82 |
| Total Drug Medicare PaymentAmount | 1582.23 |
| Total Drug Medicare Standardized Payment Amount | 1582.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 141 |
| Number Of Medical Services | 3724 |
| Number Of Medicare Beneficiaries With Medical Services | 1826 |
| Total Medical Submitted Charge Amount | 937156 |
| Total Medical Medicare Allowed Amount | 275236.99 |
| Total Medical Medicare Payment Amount | 214132.61 |
| Total Medical Medicare Standardized Payment Amount | 220701.04 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 190 |
| Number Of Beneficiaries Age 65 to 74 | 1055 |
| Number Of Beneficiaries Age 75 to 84 | 447 |
| Number Of Beneficiaries Age Greater 84 | 134 |
| Number Of Female Beneficiaries | 1301 |
| Number Of Male Beneficiaries | 525 |
| Number Of Non Hispanic White Beneficiaries | 1446 |
| Number Of Black or African American Beneficiaries | 77 |
| Number Of AsianPacific Islander Beneficiaries | 39 |
| Number Of Hispanic Beneficiaries | 227 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1589 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 237 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1989 |