| National Provider Identifier [NPI]: | 1386600468 |
| Last Name Of The Provider | LAGORE |
| First Name Of The Provider | SHANE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | NP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 781 LAKESHIRE TRL |
| Street Address 2 Of The Provider | |
| City Of The Provider | ADRIAN |
| Zip Code Of The Provider | 492211561 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 1360 |
| Number Of Medicare Beneficiaries | 518 |
| Total Submitted Charge Amount | 169266 |
| Total Medicare Allowed Amount | 97963.98 |
| Total Medicare Payment Amount | 67264.35 |
| Total Medicare Standardized Payment Amount | 84723.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 33 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 1132 |
| Total Drug Medicare AllowedAmount | 675.66 |
| Total Drug Medicare PaymentAmount | 649.4 |
| Total Drug Medicare Standardized Payment Amount | 649.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 1327 |
| Number Of Medicare Beneficiaries With Medical Services | 518 |
| Total Medical Submitted Charge Amount | 168134 |
| Total Medical Medicare Allowed Amount | 97288.32 |
| Total Medical Medicare Payment Amount | 66614.95 |
| Total Medical Medicare Standardized Payment Amount | 84074.08 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 141 |
| Number Of Beneficiaries Age 75 to 84 | 177 |
| Number Of Beneficiaries Age Greater 84 | 165 |
| Number Of Female Beneficiaries | 305 |
| Number Of Male Beneficiaries | 213 |
| Number Of Non Hispanic White Beneficiaries | 487 |
| 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 | 411 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 107 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2791 |