| National Provider Identifier [NPI]: | 1861410458 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | SHELLEY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | CFNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1900 GRANDVIEW DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRENADA |
| Zip Code Of The Provider | 389015066 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 1006.5 |
| Number Of Medicare Beneficiaries | 153 |
| Total Submitted Charge Amount | 67847.8 |
| Total Medicare Allowed Amount | 26402.12 |
| Total Medicare Payment Amount | 19939.99 |
| Total Medicare Standardized Payment Amount | 25553.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 331.5 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 17869.8 |
| Total Drug Medicare AllowedAmount | 3948.14 |
| Total Drug Medicare PaymentAmount | 2804.47 |
| Total Drug Medicare Standardized Payment Amount | 2804.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 675 |
| Number Of Medicare Beneficiaries With Medical Services | 153 |
| Total Medical Submitted Charge Amount | 49978 |
| Total Medical Medicare Allowed Amount | 22453.98 |
| Total Medical Medicare Payment Amount | 17135.52 |
| Total Medical Medicare Standardized Payment Amount | 22749.32 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 82 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | 123 |
| 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 | 113 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| 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 | 18 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 13 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6345 |