| National Provider Identifier [NPI]: | 1003802968 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | STANLEY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 AINSWORTH DR |
| Street Address 2 Of The Provider | SUITE 115 |
| City Of The Provider | PRESCOTT |
| Zip Code Of The Provider | 863051667 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 212 |
| Number Of Services | 16130 |
| Number Of Medicare Beneficiaries | 4009 |
| Total Submitted Charge Amount | 1283974 |
| Total Medicare Allowed Amount | 363631.75 |
| Total Medicare Payment Amount | 277625.49 |
| Total Medicare Standardized Payment Amount | 283552.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 9295 |
| Number Of Medicare Beneficiaries With Drug Services | 138 |
| Total Drug Submitted ChargeAmount | 11279 |
| Total Drug Medicare AllowedAmount | 2916.72 |
| Total Drug Medicare PaymentAmount | 2220.61 |
| Total Drug Medicare Standardized Payment Amount | 2220.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 210 |
| Number Of Medical Services | 6835 |
| Number Of Medicare Beneficiaries With Medical Services | 4008 |
| Total Medical Submitted Charge Amount | 1272695 |
| Total Medical Medicare Allowed Amount | 360715.03 |
| Total Medical Medicare Payment Amount | 275404.88 |
| Total Medical Medicare Standardized Payment Amount | 281332.35 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 332 |
| Number Of Beneficiaries Age 65 to 74 | 1773 |
| Number Of Beneficiaries Age 75 to 84 | 1310 |
| Number Of Beneficiaries Age Greater 84 | 594 |
| Number Of Female Beneficiaries | 2490 |
| Number Of Male Beneficiaries | 1519 |
| Number Of Non Hispanic White Beneficiaries | 3778 |
| Number Of Black or African American Beneficiaries | 17 |
| Number Of AsianPacific Islander Beneficiaries | 23 |
| Number Of Hispanic Beneficiaries | 134 |
| Number Of American Indian Alaska Native Beneficiaries | 14 |
| Number Of Beneficiaries With Race Not Else where Classified | 43 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3614 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 395 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.2277 |