| National Provider Identifier [NPI]: | 1396740585 |
| Last Name Of The Provider | MARSHALL |
| First Name Of The Provider | STEVENS |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 407 N MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MIDDLEBURY |
| Zip Code Of The Provider | 465409218 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 2283 |
| Number Of Medicare Beneficiaries | 388 |
| Total Submitted Charge Amount | 272270.86 |
| Total Medicare Allowed Amount | 225500.23 |
| Total Medicare Payment Amount | 160330.09 |
| Total Medicare Standardized Payment Amount | 167864.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 73 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 1034.56 |
| Total Drug Medicare AllowedAmount | 869.17 |
| Total Drug Medicare PaymentAmount | 832.55 |
| Total Drug Medicare Standardized Payment Amount | 832.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 2210 |
| Number Of Medicare Beneficiaries With Medical Services | 388 |
| Total Medical Submitted Charge Amount | 271236.3 |
| Total Medical Medicare Allowed Amount | 224631.06 |
| Total Medical Medicare Payment Amount | 159497.54 |
| Total Medical Medicare Standardized Payment Amount | 167031.8 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 72 |
| Number Of Beneficiaries Age 75 to 84 | 88 |
| Number Of Beneficiaries Age Greater 84 | 175 |
| Number Of Female Beneficiaries | 268 |
| Number Of Male Beneficiaries | 120 |
| Number Of Non Hispanic White Beneficiaries | 340 |
| 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 | 249 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 139 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 62 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.1319 |