| National Provider Identifier [NPI]: | 1205876505 |
| Last Name Of The Provider | CONWELL |
| First Name Of The Provider | STEPHANIE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 18101 LORAIN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CLEVELAND |
| Zip Code Of The Provider | 441115612 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 298 |
| Number Of Medicare Beneficiaries | 192 |
| Total Submitted Charge Amount | 215829 |
| Total Medicare Allowed Amount | 33364.52 |
| Total Medicare Payment Amount | 24988.73 |
| Total Medicare Standardized Payment Amount | 24457.53 |
| 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 | 20 |
| Number Of Medical Services | 298 |
| Number Of Medicare Beneficiaries With Medical Services | 192 |
| Total Medical Submitted Charge Amount | 215829 |
| Total Medical Medicare Allowed Amount | 33364.52 |
| Total Medical Medicare Payment Amount | 24988.73 |
| Total Medical Medicare Standardized Payment Amount | 24457.53 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 105 |
| Number Of Beneficiaries Age 65 to 74 | 36 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 113 |
| Number Of Male Beneficiaries | 79 |
| Number Of Non Hispanic White Beneficiaries | 141 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 89 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 103 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 21 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.8015 |