| National Provider Identifier [NPI]: | 1407859994 |
| Last Name Of The Provider | SHIPE |
| First Name Of The Provider | TERRY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 306 E MAUMEE ST |
| Street Address 2 Of The Provider | SUITE 2 |
| City Of The Provider | ANGOLA |
| Zip Code Of The Provider | 467032038 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 1015 |
| Number Of Medicare Beneficiaries | 311 |
| Total Submitted Charge Amount | 117742.97 |
| Total Medicare Allowed Amount | 61468.67 |
| Total Medicare Payment Amount | 37634.77 |
| Total Medicare Standardized Payment Amount | 41219.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 84 |
| Number Of Medicare Beneficiaries With Drug Services | 57 |
| Total Drug Submitted ChargeAmount | 6176 |
| Total Drug Medicare AllowedAmount | 1334.29 |
| Total Drug Medicare PaymentAmount | 1248.17 |
| Total Drug Medicare Standardized Payment Amount | 1248.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 931 |
| Number Of Medicare Beneficiaries With Medical Services | 311 |
| Total Medical Submitted Charge Amount | 111566.97 |
| Total Medical Medicare Allowed Amount | 60134.38 |
| Total Medical Medicare Payment Amount | 36386.6 |
| Total Medical Medicare Standardized Payment Amount | 39971.31 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 135 |
| Number Of Beneficiaries Age 75 to 84 | 95 |
| Number Of Beneficiaries Age Greater 84 | 35 |
| Number Of Female Beneficiaries | 183 |
| Number Of Male Beneficiaries | 128 |
| 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 | 268 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 43 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.8752 |