| National Provider Identifier [NPI]: | 1497865885 |
| Last Name Of The Provider | RANDOLPH |
| First Name Of The Provider | ALICE |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | EDD MSCP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 205 SE CATAWBA RD |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | PORT CLINTON |
| Zip Code Of The Provider | 434522666 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Clinical Psychologist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 890 |
| Number Of Medicare Beneficiaries | 334 |
| Total Submitted Charge Amount | 171805 |
| Total Medicare Allowed Amount | 80484.08 |
| Total Medicare Payment Amount | 61724.62 |
| Total Medicare Standardized Payment Amount | 62077.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 890 |
| Number Of Medicare Beneficiaries With Medical Services | 334 |
| Total Medical Submitted Charge Amount | 171805 |
| Total Medical Medicare Allowed Amount | 80484.08 |
| Total Medical Medicare Payment Amount | 61724.62 |
| Total Medical Medicare Standardized Payment Amount | 62077.92 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 97 |
| Number Of Beneficiaries Age 65 to 74 | 90 |
| Number Of Beneficiaries Age 75 to 84 | 66 |
| Number Of Beneficiaries Age Greater 84 | 81 |
| Number Of Female Beneficiaries | 208 |
| Number Of Male Beneficiaries | 126 |
| Number Of Non Hispanic White Beneficiaries | 263 |
| 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 | 74 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 260 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 61 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 52 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 44 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 58 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 63 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 41 |
| Percent Of With Stroke | 22 |
| Average HCC Risk Score Of Beneficiaries | 3.2875 |