| National Provider Identifier [NPI]: | 1265463517 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | EDWARD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1401 N 4TH AVE |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | PURCELL |
| Zip Code Of The Provider | 730801806 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 2504 |
| Number Of Medicare Beneficiaries | 327 |
| Total Submitted Charge Amount | 161904.19 |
| Total Medicare Allowed Amount | 111099.95 |
| Total Medicare Payment Amount | 75626.92 |
| Total Medicare Standardized Payment Amount | 85125.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 252 |
| Number Of Medicare Beneficiaries With Drug Services | 80 |
| Total Drug Submitted ChargeAmount | 4525 |
| Total Drug Medicare AllowedAmount | 1365.37 |
| Total Drug Medicare PaymentAmount | 1034.47 |
| Total Drug Medicare Standardized Payment Amount | 1034.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 2252 |
| Number Of Medicare Beneficiaries With Medical Services | 327 |
| Total Medical Submitted Charge Amount | 157379.19 |
| Total Medical Medicare Allowed Amount | 109734.58 |
| Total Medical Medicare Payment Amount | 74592.45 |
| Total Medical Medicare Standardized Payment Amount | 84091.2 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 102 |
| Number Of Beneficiaries Age 65 to 74 | 125 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 175 |
| Number Of Male Beneficiaries | 152 |
| Number Of Non Hispanic White Beneficiaries | 294 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 15 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 206 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 121 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1394 |