| National Provider Identifier [NPI]: | 1780649889 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | TODD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 407 12TH STREET EXT |
| Street Address 2 Of The Provider | |
| City Of The Provider | PRINCETON |
| Zip Code Of The Provider | 247402300 |
| State Code Of The Provider | WV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 4401 |
| Number Of Medicare Beneficiaries | 530 |
| Total Submitted Charge Amount | 245068.15 |
| Total Medicare Allowed Amount | 213748.01 |
| Total Medicare Payment Amount | 145683.18 |
| Total Medicare Standardized Payment Amount | 150535.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 1871 |
| Number Of Medicare Beneficiaries With Drug Services | 189 |
| Total Drug Submitted ChargeAmount | 24098.2 |
| Total Drug Medicare AllowedAmount | 19487.92 |
| Total Drug Medicare PaymentAmount | 15392.57 |
| Total Drug Medicare Standardized Payment Amount | 15392.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 2530 |
| Number Of Medicare Beneficiaries With Medical Services | 530 |
| Total Medical Submitted Charge Amount | 220969.95 |
| Total Medical Medicare Allowed Amount | 194260.09 |
| Total Medical Medicare Payment Amount | 130290.61 |
| Total Medical Medicare Standardized Payment Amount | 135142.77 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 211 |
| Number Of Beneficiaries Age 75 to 84 | 166 |
| Number Of Beneficiaries Age Greater 84 | 73 |
| Number Of Female Beneficiaries | 313 |
| Number Of Male Beneficiaries | 217 |
| Number Of Non Hispanic White Beneficiaries | 513 |
| 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 | 436 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 94 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2053 |