| National Provider Identifier [NPI]: | 1558340554 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | EILEEN |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 228 W BIRCH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WALLA WALLA |
| Zip Code Of The Provider | 993622935 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 69 |
| Number Of Services | 4514 |
| Number Of Medicare Beneficiaries | 960 |
| Total Submitted Charge Amount | 616785.6 |
| Total Medicare Allowed Amount | 295391.85 |
| Total Medicare Payment Amount | 207155.01 |
| Total Medicare Standardized Payment Amount | 203418.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 183 |
| Number Of Medicare Beneficiaries With Drug Services | 88 |
| Total Drug Submitted ChargeAmount | 43355.97 |
| Total Drug Medicare AllowedAmount | 33940.29 |
| Total Drug Medicare PaymentAmount | 26471.67 |
| Total Drug Medicare Standardized Payment Amount | 26471.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 67 |
| Number Of Medical Services | 4331 |
| Number Of Medicare Beneficiaries With Medical Services | 960 |
| Total Medical Submitted Charge Amount | 573429.63 |
| Total Medical Medicare Allowed Amount | 261451.56 |
| Total Medical Medicare Payment Amount | 180683.34 |
| Total Medical Medicare Standardized Payment Amount | 176946.75 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 36 |
| Number Of Beneficiaries Age 65 to 74 | 472 |
| Number Of Beneficiaries Age 75 to 84 | 322 |
| Number Of Beneficiaries Age Greater 84 | 130 |
| Number Of Female Beneficiaries | 567 |
| Number Of Male Beneficiaries | 393 |
| Number Of Non Hispanic White Beneficiaries | 936 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 924 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 36 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8951 |