| National Provider Identifier [NPI]: | 1013010305 |
| Last Name Of The Provider | SHOUP |
| First Name Of The Provider | SCOTT |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 901 W MEMORIAL DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | HOUGHTON |
| Zip Code Of The Provider | 49931 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 3389 |
| Number Of Medicare Beneficiaries | 92 |
| Total Submitted Charge Amount | 113644.59 |
| Total Medicare Allowed Amount | 38365.94 |
| Total Medicare Payment Amount | 24779.3 |
| Total Medicare Standardized Payment Amount | 25905.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 3133 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 19939.17 |
| Total Drug Medicare AllowedAmount | 18103.3 |
| Total Drug Medicare PaymentAmount | 13676.17 |
| Total Drug Medicare Standardized Payment Amount | 13676.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 5 |
| Number Of Medical Services | 256 |
| Number Of Medicare Beneficiaries With Medical Services | 92 |
| Total Medical Submitted Charge Amount | 93705.42 |
| Total Medical Medicare Allowed Amount | 20262.64 |
| Total Medical Medicare Payment Amount | 11103.13 |
| Total Medical Medicare Standardized Payment Amount | 12229.11 |
| Average Age Of Beneficiaries | 51 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 35 |
| Number Of Male Beneficiaries | 57 |
| 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 | 17 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 75 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 39 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 14 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 62 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1852 |