| National Provider Identifier [NPI]: | 1457314122 |
| Last Name Of The Provider | BELLES |
| First Name Of The Provider | TERRY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 145 SHAFFER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTH WILLIAMSPORT |
| Zip Code Of The Provider | 177026727 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 393 |
| Number Of Medicare Beneficiaries | 264 |
| Total Submitted Charge Amount | 63131 |
| Total Medicare Allowed Amount | 28607.92 |
| Total Medicare Payment Amount | 19581.56 |
| Total Medicare Standardized Payment Amount | 20489.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 18 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 500 |
| Total Drug Medicare AllowedAmount | 221.86 |
| Total Drug Medicare PaymentAmount | 187.67 |
| Total Drug Medicare Standardized Payment Amount | 187.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 375 |
| Number Of Medicare Beneficiaries With Medical Services | 264 |
| Total Medical Submitted Charge Amount | 62631 |
| Total Medical Medicare Allowed Amount | 28386.06 |
| Total Medical Medicare Payment Amount | 19393.89 |
| Total Medical Medicare Standardized Payment Amount | 20301.9 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 113 |
| Number Of Beneficiaries Age 75 to 84 | 65 |
| Number Of Beneficiaries Age Greater 84 | 47 |
| Number Of Female Beneficiaries | 164 |
| Number Of Male Beneficiaries | 100 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 233 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9431 |