| National Provider Identifier [NPI]: | 1659449270 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | JESSE |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 333 BORTHWICK AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORTSMOUTH |
| Zip Code Of The Provider | 038017128 |
| State Code Of The Provider | NH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 199 |
| Number Of Services | 6567 |
| Number Of Medicare Beneficiaries | 3422 |
| Total Submitted Charge Amount | 849984.5 |
| Total Medicare Allowed Amount | 221898.29 |
| Total Medicare Payment Amount | 174854.74 |
| Total Medicare Standardized Payment Amount | 174016.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 199 |
| Number Of Medical Services | 6567 |
| Number Of Medicare Beneficiaries With Medical Services | 3422 |
| Total Medical Submitted Charge Amount | 849984.5 |
| Total Medical Medicare Allowed Amount | 221898.29 |
| Total Medical Medicare Payment Amount | 174854.74 |
| Total Medical Medicare Standardized Payment Amount | 174016.77 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 459 |
| Number Of Beneficiaries Age 65 to 74 | 1436 |
| Number Of Beneficiaries Age 75 to 84 | 1066 |
| Number Of Beneficiaries Age Greater 84 | 461 |
| Number Of Female Beneficiaries | 2233 |
| Number Of Male Beneficiaries | 1189 |
| Number Of Non Hispanic White Beneficiaries | 3295 |
| Number Of Black or African American Beneficiaries | 37 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 60 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2931 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 491 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.2992 |