| National Provider Identifier [NPI]: | 1902911449 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | TRACY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7901 S 12TH ST |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | PORTAGE |
| Zip Code Of The Provider | 490243831 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 2019 |
| Number Of Medicare Beneficiaries | 156 |
| Total Submitted Charge Amount | 118369 |
| Total Medicare Allowed Amount | 43849.87 |
| Total Medicare Payment Amount | 32339.42 |
| Total Medicare Standardized Payment Amount | 35533.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 1665 |
| Number Of Medicare Beneficiaries With Drug Services | 68 |
| Total Drug Submitted ChargeAmount | 41456 |
| Total Drug Medicare AllowedAmount | 20183.4 |
| Total Drug Medicare PaymentAmount | 14596.19 |
| Total Drug Medicare Standardized Payment Amount | 14596.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 354 |
| Number Of Medicare Beneficiaries With Medical Services | 156 |
| Total Medical Submitted Charge Amount | 76913 |
| Total Medical Medicare Allowed Amount | 23666.47 |
| Total Medical Medicare Payment Amount | 17743.23 |
| Total Medical Medicare Standardized Payment Amount | 20937.77 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 65 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 94 |
| Number Of Male Beneficiaries | 62 |
| Number Of Non Hispanic White Beneficiaries | 130 |
| 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 | 104 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0424 |