| National Provider Identifier [NPI]: | 1346356862 |
| Last Name Of The Provider | SANFORD |
| First Name Of The Provider | TRACY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1151 S BELMONT AVE |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | OKMULGEE |
| Zip Code Of The Provider | 744476307 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 2762 |
| Number Of Medicare Beneficiaries | 430 |
| Total Submitted Charge Amount | 220663.5 |
| Total Medicare Allowed Amount | 140722.95 |
| Total Medicare Payment Amount | 96171.48 |
| Total Medicare Standardized Payment Amount | 108067.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 608 |
| Number Of Medicare Beneficiaries With Drug Services | 213 |
| Total Drug Submitted ChargeAmount | 18774 |
| Total Drug Medicare AllowedAmount | 6223.51 |
| Total Drug Medicare PaymentAmount | 5192.36 |
| Total Drug Medicare Standardized Payment Amount | 5192.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 2154 |
| Number Of Medicare Beneficiaries With Medical Services | 429 |
| Total Medical Submitted Charge Amount | 201889.5 |
| Total Medical Medicare Allowed Amount | 134499.44 |
| Total Medical Medicare Payment Amount | 90979.12 |
| Total Medical Medicare Standardized Payment Amount | 102875.21 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 213 |
| Number Of Beneficiaries Age 75 to 84 | 120 |
| Number Of Beneficiaries Age Greater 84 | 44 |
| Number Of Female Beneficiaries | 405 |
| Number Of Male Beneficiaries | 25 |
| Number Of Non Hispanic White Beneficiaries | 352 |
| Number Of Black or African American Beneficiaries | 56 |
| 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 | 340 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 90 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8517 |