| National Provider Identifier [NPI]: | 1265422950 |
| Last Name Of The Provider | BRAIG |
| First Name Of The Provider | KRISTEN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2211 TIMBER TRL |
| Street Address 2 Of The Provider | MAPLE LEAF FAMILY AND SPORTS MEDICINE |
| City Of The Provider | BELLEFONTAINE |
| Zip Code Of The Provider | 433119036 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 1226 |
| Number Of Medicare Beneficiaries | 284 |
| Total Submitted Charge Amount | 104198.58 |
| Total Medicare Allowed Amount | 71451.66 |
| Total Medicare Payment Amount | 48088.15 |
| Total Medicare Standardized Payment Amount | 50776.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 273 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 8228.73 |
| Total Drug Medicare AllowedAmount | 3861.53 |
| Total Drug Medicare PaymentAmount | 3132.27 |
| Total Drug Medicare Standardized Payment Amount | 3132.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 953 |
| Number Of Medicare Beneficiaries With Medical Services | 284 |
| Total Medical Submitted Charge Amount | 95969.85 |
| Total Medical Medicare Allowed Amount | 67590.13 |
| Total Medical Medicare Payment Amount | 44955.88 |
| Total Medical Medicare Standardized Payment Amount | 47644.71 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 149 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 189 |
| Number Of Male Beneficiaries | 95 |
| Number Of Non Hispanic White Beneficiaries | 267 |
| Number Of Black or African American Beneficiaries | |
| 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 | 229 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 55 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0388 |