| National Provider Identifier [NPI]: | 1366519563 |
| Last Name Of The Provider | SHAW |
| First Name Of The Provider | TABITHA |
| 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 | 8195 HIGHWAY 789 |
| Street Address 2 Of The Provider | |
| City Of The Provider | LANDER |
| Zip Code Of The Provider | 825202942 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 118 |
| Number Of Services | 1784 |
| Number Of Medicare Beneficiaries | 141 |
| Total Submitted Charge Amount | 96758.48 |
| Total Medicare Allowed Amount | 28889.76 |
| Total Medicare Payment Amount | 21271.64 |
| Total Medicare Standardized Payment Amount | 21634.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 366 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 2077.48 |
| Total Drug Medicare AllowedAmount | 169.94 |
| Total Drug Medicare PaymentAmount | 96.67 |
| Total Drug Medicare Standardized Payment Amount | 96.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 111 |
| Number Of Medical Services | 1418 |
| Number Of Medicare Beneficiaries With Medical Services | 140 |
| Total Medical Submitted Charge Amount | 94681 |
| Total Medical Medicare Allowed Amount | 28719.82 |
| Total Medical Medicare Payment Amount | 21174.97 |
| Total Medical Medicare Standardized Payment Amount | 21537.63 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 64 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 91 |
| Number Of Male Beneficiaries | 50 |
| Number Of Non Hispanic White Beneficiaries | 0 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 141 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 70 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 71 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 23 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 20 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2282 |