| National Provider Identifier [NPI]: | 1396095360 |
| Last Name Of The Provider | SONG |
| First Name Of The Provider | KATHY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1401 W LOCUST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | STILWELL |
| Zip Code Of The Provider | 749603275 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 415 |
| Number Of Medicare Beneficiaries | 77 |
| Total Submitted Charge Amount | 17579.31 |
| Total Medicare Allowed Amount | 8931.43 |
| Total Medicare Payment Amount | 7645.94 |
| Total Medicare Standardized Payment Amount | 8599.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 32 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 727 |
| Total Drug Medicare AllowedAmount | 620.91 |
| Total Drug Medicare PaymentAmount | 608.52 |
| Total Drug Medicare Standardized Payment Amount | 608.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 383 |
| Number Of Medicare Beneficiaries With Medical Services | 77 |
| Total Medical Submitted Charge Amount | 16852.31 |
| Total Medical Medicare Allowed Amount | 8310.52 |
| Total Medical Medicare Payment Amount | 7037.42 |
| Total Medical Medicare Standardized Payment Amount | 7990.73 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 41 |
| Number Of Beneficiaries Age 75 to 84 | 19 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 47 |
| Number Of Male Beneficiaries | 30 |
| Number Of Non Hispanic White Beneficiaries | 11 |
| 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 | 66 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 52 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 61 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2978 |