| National Provider Identifier [NPI]: | 1023265816 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | LEO |
| 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 | 500 DOYLE PARK DR |
| Street Address 2 Of The Provider | SUITE G-04 |
| City Of The Provider | SANTA ROSA |
| Zip Code Of The Provider | 954054558 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 1270 |
| Number Of Medicare Beneficiaries | 419 |
| Total Submitted Charge Amount | 137781 |
| Total Medicare Allowed Amount | 91253.16 |
| Total Medicare Payment Amount | 67669.48 |
| Total Medicare Standardized Payment Amount | 65372.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 283 |
| Number Of Medicare Beneficiaries With Drug Services | 111 |
| Total Drug Submitted ChargeAmount | 12378 |
| Total Drug Medicare AllowedAmount | 6278.46 |
| Total Drug Medicare PaymentAmount | 5942.85 |
| Total Drug Medicare Standardized Payment Amount | 5942.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 987 |
| Number Of Medicare Beneficiaries With Medical Services | 418 |
| Total Medical Submitted Charge Amount | 125403 |
| Total Medical Medicare Allowed Amount | 84974.7 |
| Total Medical Medicare Payment Amount | 61726.63 |
| Total Medical Medicare Standardized Payment Amount | 59429.73 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 185 |
| Number Of Beneficiaries Age 75 to 84 | 118 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 235 |
| Number Of Male Beneficiaries | 184 |
| Number Of Non Hispanic White Beneficiaries | 389 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 373 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 46 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0302 |