| National Provider Identifier [NPI]: | 1619961117 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | BRADLEY |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 275 N. EL CIELO |
| Street Address 2 Of The Provider | |
| City Of The Provider | PALM SPRINGS |
| Zip Code Of The Provider | 92262 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 54 |
| Number Of Medicare Beneficiaries | 24 |
| Total Submitted Charge Amount | 4728 |
| Total Medicare Allowed Amount | 2300.51 |
| Total Medicare Payment Amount | 1511.76 |
| Total Medicare Standardized Payment Amount | 1446.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 174 |
| Total Drug Medicare AllowedAmount | 44.2 |
| Total Drug Medicare PaymentAmount | 37.14 |
| Total Drug Medicare Standardized Payment Amount | 37.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 11 |
| Number Of Medical Services | 34 |
| Number Of Medicare Beneficiaries With Medical Services | 21 |
| Total Medical Submitted Charge Amount | 4554 |
| Total Medical Medicare Allowed Amount | 2256.31 |
| Total Medical Medicare Payment Amount | 1474.62 |
| Total Medical Medicare Standardized Payment Amount | 1409.19 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 11 |
| Number Of Male Beneficiaries | 13 |
| 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 | 0 |
| 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 | |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.8526 |