| National Provider Identifier [NPI]: | 1770694572 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12121 RICHMOND AVE |
| Street Address 2 Of The Provider | #106 |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770822432 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 2450 |
| Number Of Medicare Beneficiaries | 381 |
| Total Submitted Charge Amount | 140758.27 |
| Total Medicare Allowed Amount | 137054.85 |
| Total Medicare Payment Amount | 96815.38 |
| Total Medicare Standardized Payment Amount | 96348.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 138 |
| Number Of Medicare Beneficiaries With Drug Services | 133 |
| Total Drug Submitted ChargeAmount | 2745.24 |
| Total Drug Medicare AllowedAmount | 2086.2 |
| Total Drug Medicare PaymentAmount | 2044.83 |
| Total Drug Medicare Standardized Payment Amount | 2044.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 2312 |
| Number Of Medicare Beneficiaries With Medical Services | 381 |
| Total Medical Submitted Charge Amount | 138013.03 |
| Total Medical Medicare Allowed Amount | 134968.65 |
| Total Medical Medicare Payment Amount | 94770.55 |
| Total Medical Medicare Standardized Payment Amount | 94303.93 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 143 |
| Number Of Beneficiaries Age 75 to 84 | 157 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 211 |
| Number Of Male Beneficiaries | 170 |
| Number Of Non Hispanic White Beneficiaries | 340 |
| Number Of Black or African American Beneficiaries | 20 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 354 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.016 |