| National Provider Identifier [NPI]: | 1124107925 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | DPM FACFAS |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14641 NEWPORT AVENUE |
| Street Address 2 Of The Provider | SUITE 105 |
| City Of The Provider | TUSTIN |
| Zip Code Of The Provider | 92780 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 277 |
| Number Of Medicare Beneficiaries | 52 |
| Total Submitted Charge Amount | 29280.47 |
| Total Medicare Allowed Amount | 23393.06 |
| Total Medicare Payment Amount | 17524.95 |
| Total Medicare Standardized Payment Amount | 16996.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 46 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 222.5 |
| Total Drug Medicare AllowedAmount | 131.29 |
| Total Drug Medicare PaymentAmount | 96.75 |
| Total Drug Medicare Standardized Payment Amount | 96.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 231 |
| Number Of Medicare Beneficiaries With Medical Services | 52 |
| Total Medical Submitted Charge Amount | 29057.97 |
| Total Medical Medicare Allowed Amount | 23261.77 |
| Total Medical Medicare Payment Amount | 17428.2 |
| Total Medical Medicare Standardized Payment Amount | 16899.99 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 19 |
| Number Of Beneficiaries Age 75 to 84 | 22 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 34 |
| Number Of Male Beneficiaries | 18 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0005 |