| National Provider Identifier [NPI]: | 1639170749 |
| Last Name Of The Provider | CHURCH |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1707 INDUSTRIAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | WILKESBORO |
| Zip Code Of The Provider | 286977345 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 1371 |
| Number Of Medicare Beneficiaries | 135 |
| Total Submitted Charge Amount | 81419.74 |
| Total Medicare Allowed Amount | 69015.85 |
| Total Medicare Payment Amount | 46136.69 |
| Total Medicare Standardized Payment Amount | 51251.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 90 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 1782 |
| Total Drug Medicare AllowedAmount | 652.72 |
| Total Drug Medicare PaymentAmount | 601.44 |
| Total Drug Medicare Standardized Payment Amount | 601.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 1281 |
| Number Of Medicare Beneficiaries With Medical Services | 135 |
| Total Medical Submitted Charge Amount | 79637.74 |
| Total Medical Medicare Allowed Amount | 68363.13 |
| Total Medical Medicare Payment Amount | 45535.25 |
| Total Medical Medicare Standardized Payment Amount | 50650.47 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 83 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 83 |
| Number Of Male Beneficiaries | 52 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8006 |