| National Provider Identifier [NPI]: | 1356549406 |
| Last Name Of The Provider | FOSTER |
| First Name Of The Provider | SHANNON |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 W BROADWAY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MISSOULA |
| Zip Code Of The Provider | 598024008 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 4976 |
| Number Of Medicare Beneficiaries | 1146 |
| Total Submitted Charge Amount | 513672.5 |
| Total Medicare Allowed Amount | 268662.65 |
| Total Medicare Payment Amount | 179995.31 |
| Total Medicare Standardized Payment Amount | 180266.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 31 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 9805 |
| Total Drug Medicare AllowedAmount | 7640.5 |
| Total Drug Medicare PaymentAmount | 5806.59 |
| Total Drug Medicare Standardized Payment Amount | 5806.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 4945 |
| Number Of Medicare Beneficiaries With Medical Services | 1146 |
| Total Medical Submitted Charge Amount | 503867.5 |
| Total Medical Medicare Allowed Amount | 261022.15 |
| Total Medical Medicare Payment Amount | 174188.72 |
| Total Medical Medicare Standardized Payment Amount | 174459.69 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 78 |
| Number Of Beneficiaries Age 65 to 74 | 634 |
| Number Of Beneficiaries Age 75 to 84 | 320 |
| Number Of Beneficiaries Age Greater 84 | 114 |
| Number Of Female Beneficiaries | 625 |
| Number Of Male Beneficiaries | 521 |
| Number Of Non Hispanic White Beneficiaries | 1103 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1064 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 82 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.7971 |