| National Provider Identifier [NPI]: | 1619988318 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2 WAKE ROBIN RD |
| Street Address 2 Of The Provider | SUITE 106 |
| City Of The Provider | LINCOLN |
| Zip Code Of The Provider | 028654295 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 439 |
| Number Of Medicare Beneficiaries | 262 |
| Total Submitted Charge Amount | 61340.51 |
| Total Medicare Allowed Amount | 42831.8 |
| Total Medicare Payment Amount | 28564.33 |
| Total Medicare Standardized Payment Amount | 28681.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 421.51 |
| Total Drug Medicare AllowedAmount | 32.07 |
| Total Drug Medicare PaymentAmount | 25.15 |
| Total Drug Medicare Standardized Payment Amount | 25.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 415 |
| Number Of Medicare Beneficiaries With Medical Services | 262 |
| Total Medical Submitted Charge Amount | 60919 |
| Total Medical Medicare Allowed Amount | 42799.73 |
| Total Medical Medicare Payment Amount | 28539.18 |
| Total Medical Medicare Standardized Payment Amount | 28656.01 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 97 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | 39 |
| Number Of Female Beneficiaries | 180 |
| Number Of Male Beneficiaries | 82 |
| Number Of Non Hispanic White Beneficiaries | 245 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 187 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 75 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0419 |