| National Provider Identifier [NPI]: | 1932242542 |
| Last Name Of The Provider | SHOCKLEY |
| First Name Of The Provider | TRISTAN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14205 PARK CENTER DR |
| Street Address 2 Of The Provider | SUITE 204 |
| City Of The Provider | LAUREL |
| Zip Code Of The Provider | 207075246 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Medicine and Rehabilitation |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 942 |
| Number Of Medicare Beneficiaries | 102 |
| Total Submitted Charge Amount | 284167.52 |
| Total Medicare Allowed Amount | 80361.58 |
| Total Medicare Payment Amount | 60124.04 |
| Total Medicare Standardized Payment Amount | 53092.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 32 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 480 |
| Total Drug Medicare AllowedAmount | 95.38 |
| Total Drug Medicare PaymentAmount | 74.78 |
| Total Drug Medicare Standardized Payment Amount | 74.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 910 |
| Number Of Medicare Beneficiaries With Medical Services | 102 |
| Total Medical Submitted Charge Amount | 283687.52 |
| Total Medical Medicare Allowed Amount | 80266.2 |
| Total Medical Medicare Payment Amount | 60049.26 |
| Total Medical Medicare Standardized Payment Amount | 53017.69 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 71 |
| Number Of Beneficiaries Age 65 to 74 | 20 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 65 |
| Number Of Male Beneficiaries | 37 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 64 |
| 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 | 47 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 55 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.6286 |