| National Provider Identifier [NPI]: | 1073554267 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | BONNIE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1241 W STADIUM BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | JEFFERSON CITY |
| Zip Code Of The Provider | 651096023 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 172 |
| Number Of Services | 7093 |
| Number Of Medicare Beneficiaries | 3764 |
| Total Submitted Charge Amount | 420058 |
| Total Medicare Allowed Amount | 188346.93 |
| Total Medicare Payment Amount | 144688.6 |
| Total Medicare Standardized Payment Amount | 152487.28 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 647 |
| Number Of Beneficiaries Age 65 to 74 | 1586 |
| Number Of Beneficiaries Age 75 to 84 | 1071 |
| Number Of Beneficiaries Age Greater 84 | 460 |
| Number Of Female Beneficiaries | 2392 |
| Number Of Male Beneficiaries | 1372 |
| Number Of Non Hispanic White Beneficiaries | 3609 |
| Number Of Black or African American Beneficiaries | 97 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3161 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 603 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2525 |