| National Provider Identifier [NPI]: | 1295842409 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | GLENN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2219 GARFIELD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | TWO RIVERS |
| Zip Code Of The Provider | 54241 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 1651 |
| Number Of Medicare Beneficiaries | 221 |
| Total Submitted Charge Amount | 239352.4 |
| Total Medicare Allowed Amount | 69598.88 |
| Total Medicare Payment Amount | 52788.95 |
| Total Medicare Standardized Payment Amount | 55420.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 114 |
| Number Of Medicare Beneficiaries With Drug Services | 67 |
| Total Drug Submitted ChargeAmount | 4123.4 |
| Total Drug Medicare AllowedAmount | 1966.73 |
| Total Drug Medicare PaymentAmount | 1862.94 |
| Total Drug Medicare Standardized Payment Amount | 1862.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 1537 |
| Number Of Medicare Beneficiaries With Medical Services | 220 |
| Total Medical Submitted Charge Amount | 235229 |
| Total Medical Medicare Allowed Amount | 67632.15 |
| Total Medical Medicare Payment Amount | 50926.01 |
| Total Medical Medicare Standardized Payment Amount | 53557.58 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 95 |
| Number Of Beneficiaries Age 75 to 84 | 52 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 120 |
| Number Of Male Beneficiaries | 101 |
| Number Of Non Hispanic White Beneficiaries | 206 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 176 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 45 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1026 |