| National Provider Identifier [NPI]: | 1679572853 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | WARREN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 895 ADAMS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOULDER CITY |
| Zip Code Of The Provider | 890052235 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 176 |
| Number Of Services | 22217 |
| Number Of Medicare Beneficiaries | 903 |
| Total Submitted Charge Amount | 1216780 |
| Total Medicare Allowed Amount | 727298.39 |
| Total Medicare Payment Amount | 554756.08 |
| Total Medicare Standardized Payment Amount | 539766.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 7724 |
| Number Of Medicare Beneficiaries With Drug Services | 385 |
| Total Drug Submitted ChargeAmount | 123333 |
| Total Drug Medicare AllowedAmount | 83603.02 |
| Total Drug Medicare PaymentAmount | 66818.84 |
| Total Drug Medicare Standardized Payment Amount | 66818.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 161 |
| Number Of Medical Services | 14493 |
| Number Of Medicare Beneficiaries With Medical Services | 903 |
| Total Medical Submitted Charge Amount | 1093447 |
| Total Medical Medicare Allowed Amount | 643695.37 |
| Total Medical Medicare Payment Amount | 487937.24 |
| Total Medical Medicare Standardized Payment Amount | 472947.95 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 412 |
| Number Of Beneficiaries Age 75 to 84 | 298 |
| Number Of Beneficiaries Age Greater 84 | 146 |
| Number Of Female Beneficiaries | 424 |
| Number Of Male Beneficiaries | 479 |
| Number Of Non Hispanic White Beneficiaries | 858 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 861 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9029 |