| National Provider Identifier [NPI]: | 1558444216 |
| Last Name Of The Provider | SAMPLE |
| First Name Of The Provider | SCOTT |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 801 N 29TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BILLINGS |
| Zip Code Of The Provider | 591010905 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 127 |
| Number Of Services | 4533 |
| Number Of Medicare Beneficiaries | 2558 |
| Total Submitted Charge Amount | 2033770.07 |
| Total Medicare Allowed Amount | 399205.07 |
| Total Medicare Payment Amount | 308817.73 |
| Total Medicare Standardized Payment Amount | 304911.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 44 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 2459.6 |
| Total Drug Medicare AllowedAmount | 2331.33 |
| Total Drug Medicare PaymentAmount | 1827.78 |
| Total Drug Medicare Standardized Payment Amount | 1827.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 126 |
| Number Of Medical Services | 4489 |
| Number Of Medicare Beneficiaries With Medical Services | 2558 |
| Total Medical Submitted Charge Amount | 2031310.47 |
| Total Medical Medicare Allowed Amount | 396873.74 |
| Total Medical Medicare Payment Amount | 306989.95 |
| Total Medical Medicare Standardized Payment Amount | 303084.08 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 341 |
| Number Of Beneficiaries Age 65 to 74 | 977 |
| Number Of Beneficiaries Age 75 to 84 | 817 |
| Number Of Beneficiaries Age Greater 84 | 423 |
| Number Of Female Beneficiaries | 1272 |
| Number Of Male Beneficiaries | 1286 |
| Number Of Non Hispanic White Beneficiaries | 2214 |
| Number Of Black or African American Beneficiaries | 89 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 80 |
| Number Of American Indian Alaska Native Beneficiaries | 145 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2082 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 476 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4329 |