| National Provider Identifier [NPI]: | 1588685820 |
| Last Name Of The Provider | TWOBEARS |
| First Name Of The Provider | SHANTELL |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 620 S HAYNES AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MILES CITY |
| Zip Code Of The Provider | 593014769 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 142 |
| Number Of Services | 9120 |
| Number Of Medicare Beneficiaries | 416 |
| Total Submitted Charge Amount | 537623.58 |
| Total Medicare Allowed Amount | 223966.05 |
| Total Medicare Payment Amount | 169872.83 |
| Total Medicare Standardized Payment Amount | 168553.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 48 |
| Number Of Drug Services | 6919 |
| Number Of Medicare Beneficiaries With Drug Services | 112 |
| Total Drug Submitted ChargeAmount | 329412.25 |
| Total Drug Medicare AllowedAmount | 129345.48 |
| Total Drug Medicare PaymentAmount | 101968.17 |
| Total Drug Medicare Standardized Payment Amount | 101968.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 94 |
| Number Of Medical Services | 2201 |
| Number Of Medicare Beneficiaries With Medical Services | 408 |
| Total Medical Submitted Charge Amount | 208211.33 |
| Total Medical Medicare Allowed Amount | 94620.57 |
| Total Medical Medicare Payment Amount | 67904.66 |
| Total Medical Medicare Standardized Payment Amount | 66584.85 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 171 |
| Number Of Beneficiaries Age 75 to 84 | 114 |
| Number Of Beneficiaries Age Greater 84 | 81 |
| Number Of Female Beneficiaries | 244 |
| Number Of Male Beneficiaries | 172 |
| Number Of Non Hispanic White Beneficiaries | 400 |
| 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 | 346 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 70 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0418 |