| National Provider Identifier [NPI]: | 1184696130 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | SHAUNNAH |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 17877 W 14 MILE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BEVERLY HILLS |
| Zip Code Of The Provider | 480253127 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 660 |
| Number Of Medicare Beneficiaries | 210 |
| Total Submitted Charge Amount | 173521 |
| Total Medicare Allowed Amount | 28338.68 |
| Total Medicare Payment Amount | 21505.96 |
| Total Medicare Standardized Payment Amount | 24413.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 102 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 14382 |
| Total Drug Medicare AllowedAmount | 298.81 |
| Total Drug Medicare PaymentAmount | 234.26 |
| Total Drug Medicare Standardized Payment Amount | 234.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 558 |
| Number Of Medicare Beneficiaries With Medical Services | 210 |
| Total Medical Submitted Charge Amount | 159139 |
| Total Medical Medicare Allowed Amount | 28039.87 |
| Total Medical Medicare Payment Amount | 21271.7 |
| Total Medical Medicare Standardized Payment Amount | 24179.66 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 109 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 128 |
| Number Of Male Beneficiaries | 82 |
| Number Of Non Hispanic White Beneficiaries | 188 |
| 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 | 191 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2874 |