| National Provider Identifier [NPI]: | 1083609135 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 506 S NURSERY RD |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | IRVING |
| Zip Code Of The Provider | 750603187 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 782 |
| Number Of Medicare Beneficiaries | 58 |
| Total Submitted Charge Amount | 67774.22 |
| Total Medicare Allowed Amount | 26533.11 |
| Total Medicare Payment Amount | 21946.03 |
| Total Medicare Standardized Payment Amount | 21946.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 75 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 2091 |
| Total Drug Medicare AllowedAmount | 472.79 |
| Total Drug Medicare PaymentAmount | 448.35 |
| Total Drug Medicare Standardized Payment Amount | 448.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 707 |
| Number Of Medicare Beneficiaries With Medical Services | 58 |
| Total Medical Submitted Charge Amount | 65683.22 |
| Total Medical Medicare Allowed Amount | 26060.32 |
| Total Medical Medicare Payment Amount | 21497.68 |
| Total Medical Medicare Standardized Payment Amount | 21497.68 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 16 |
| Number Of Beneficiaries Age 65 to 74 | 31 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 32 |
| Number Of Male Beneficiaries | 26 |
| 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 | 13 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 45 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 0 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1929 |