| National Provider Identifier [NPI]: | 1982717047 |
| Last Name Of The Provider | SHELL |
| First Name Of The Provider | RAEWYN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3 OAKWOOD PARK PLZ |
| Street Address 2 Of The Provider | |
| City Of The Provider | CASTLE ROCK |
| Zip Code Of The Provider | 801041887 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 69 |
| Number Of Services | 806 |
| Number Of Medicare Beneficiaries | 242 |
| Total Submitted Charge Amount | 97174.5 |
| Total Medicare Allowed Amount | 48511.79 |
| Total Medicare Payment Amount | 33723.18 |
| Total Medicare Standardized Payment Amount | 34158.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 208 |
| Number Of Medicare Beneficiaries With Drug Services | 32 |
| Total Drug Submitted ChargeAmount | 1701.5 |
| Total Drug Medicare AllowedAmount | 934.54 |
| Total Drug Medicare PaymentAmount | 899.02 |
| Total Drug Medicare Standardized Payment Amount | 899.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 598 |
| Number Of Medicare Beneficiaries With Medical Services | 242 |
| Total Medical Submitted Charge Amount | 95473 |
| Total Medical Medicare Allowed Amount | 47577.25 |
| Total Medical Medicare Payment Amount | 32824.16 |
| Total Medical Medicare Standardized Payment Amount | 33259.7 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 138 |
| Number Of Beneficiaries Age 75 to 84 | 49 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 176 |
| Number Of Male Beneficiaries | 66 |
| Number Of Non Hispanic White Beneficiaries | 221 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 222 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 5 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 14 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9279 |