| National Provider Identifier [NPI]: | 1740343995 |
| Last Name Of The Provider | MCDONALD |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 19820 HWY 410 |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | BONNEY LAKE |
| Zip Code Of The Provider | 98391 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 327 |
| Number Of Medicare Beneficiaries | 42 |
| Total Submitted Charge Amount | 19143.24 |
| Total Medicare Allowed Amount | 10936.67 |
| Total Medicare Payment Amount | 8918.97 |
| Total Medicare Standardized Payment Amount | 8957.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 12 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 383.06 |
| Total Drug Medicare AllowedAmount | 300.22 |
| Total Drug Medicare PaymentAmount | 294.22 |
| Total Drug Medicare Standardized Payment Amount | 294.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 315 |
| Number Of Medicare Beneficiaries With Medical Services | 42 |
| Total Medical Submitted Charge Amount | 18760.18 |
| Total Medical Medicare Allowed Amount | 10636.45 |
| Total Medical Medicare Payment Amount | 8624.75 |
| Total Medical Medicare Standardized Payment Amount | 8663.67 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 28 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | 0 |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 0 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 0 |
| Percent Of With Depression | |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0173 |