| National Provider Identifier [NPI]: | 1508958307 |
| Last Name Of The Provider | SCOTT |
| First Name Of The Provider | TRINA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 815 MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 616021076 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 204 |
| Number Of Medicare Beneficiaries | 39 |
| Total Submitted Charge Amount | 27732.55 |
| Total Medicare Allowed Amount | 14224.88 |
| Total Medicare Payment Amount | 9391.8 |
| Total Medicare Standardized Payment Amount | 10005.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 14 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 263.61 |
| Total Drug Medicare AllowedAmount | 194.89 |
| Total Drug Medicare PaymentAmount | 184.33 |
| Total Drug Medicare Standardized Payment Amount | 184.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 190 |
| Number Of Medicare Beneficiaries With Medical Services | 39 |
| Total Medical Submitted Charge Amount | 27468.94 |
| Total Medical Medicare Allowed Amount | 14029.99 |
| Total Medical Medicare Payment Amount | 9207.47 |
| Total Medical Medicare Standardized Payment Amount | 9820.97 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 27 |
| Number Of Male Beneficiaries | 12 |
| 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 | 17 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 0 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2691 |