| National Provider Identifier [NPI]: | 1437289311 |
| Last Name Of The Provider | SUE |
| First Name Of The Provider | LOLA |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 INDIANA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | WINSLOW |
| Zip Code Of The Provider | 860472169 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 114 |
| Number Of Services | 9709 |
| Number Of Medicare Beneficiaries | 134 |
| Total Submitted Charge Amount | 107091.45 |
| Total Medicare Allowed Amount | 106693.09 |
| Total Medicare Payment Amount | 84229.93 |
| Total Medicare Standardized Payment Amount | 84201.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 35 |
| Number Of Drug Services | 8361 |
| Number Of Medicare Beneficiaries With Drug Services | 84 |
| Total Drug Submitted ChargeAmount | 57505.25 |
| Total Drug Medicare AllowedAmount | 57352.22 |
| Total Drug Medicare PaymentAmount | 44943.98 |
| Total Drug Medicare Standardized Payment Amount | 44943.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 79 |
| Number Of Medical Services | 1348 |
| Number Of Medicare Beneficiaries With Medical Services | 134 |
| Total Medical Submitted Charge Amount | 49586.2 |
| Total Medical Medicare Allowed Amount | 49340.87 |
| Total Medical Medicare Payment Amount | 39285.95 |
| Total Medical Medicare Standardized Payment Amount | 39257.34 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 45 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 68 |
| Number Of Male Beneficiaries | 66 |
| Number Of Non Hispanic White Beneficiaries | 0 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 134 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 30 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 104 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.1783 |