| National Provider Identifier [NPI]: | 1104037357 |
| Last Name Of The Provider | LANE |
| First Name Of The Provider | ISABELLE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9480 ROSEMONT DR STE 100 |
| Street Address 2 Of The Provider | |
| City Of The Provider | STREETSBORO |
| Zip Code Of The Provider | 442414569 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 782 |
| Number Of Medicare Beneficiaries | 143 |
| Total Submitted Charge Amount | 81738 |
| Total Medicare Allowed Amount | 58645.77 |
| Total Medicare Payment Amount | 39930.54 |
| Total Medicare Standardized Payment Amount | 42487.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 75 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 2482 |
| Total Drug Medicare AllowedAmount | 1305.05 |
| Total Drug Medicare PaymentAmount | 1257.39 |
| Total Drug Medicare Standardized Payment Amount | 1257.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 707 |
| Number Of Medicare Beneficiaries With Medical Services | 143 |
| Total Medical Submitted Charge Amount | 79256 |
| Total Medical Medicare Allowed Amount | 57340.72 |
| Total Medical Medicare Payment Amount | 38673.15 |
| Total Medical Medicare Standardized Payment Amount | 41229.98 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 57 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 113 |
| Number Of Male Beneficiaries | 30 |
| 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 | 115 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0535 |