Supplementary Exhibit 4.  Beneficiaries Attributed to Your TIN for the Medicare Spending per Beneficiary Measure									Supplementary Exhibit 4.  Beneficiaries Attributed to Your TIN for the Medicare Spending per Beneficiary Measure							Supplementary Exhibit 4.  Beneficiaries Attributed to Your TIN for the Medicare Spending per Beneficiary Measure											Supplementary Exhibit 4.  Beneficiaries Attributed to Your TIN for the Medicare Spending per Beneficiary Measure												Supplementary Exhibit 4.  Beneficiaries Attributed to Your TIN for the Medicare Spending per Beneficiary Measure		
																																									
																																									
Beneficiaries Attributed to Your TIN for the Medicare Spending per Beneficiary Measure					Apparent Lead Eligible Professional			Total Payment-Standardized Episode Cost	Characteristics of Hospital Admission							Discharge Disposition			"Medicare Spending per Beneficiary, by Category of Service Furnished by All Providers"																						
HIC	Gender	DOB	Index	HCC Percentile Ranking	NPI	Name	Specialty 		Date of Admission	"Admitting Hospital
(Name, CCN, City, State)"				"Principal Diagnosis
(Code, Description)"		Date of Discharge	"Discharge Status
(Code, Description)"		 Evaluation and Management Services* 	 Major Procedures and Anesthesia* 	" Ambulatory/
Minor Procedures* "	" Outpatient Physical, Occupational, or Speech and Language Pathology  Therapy* "	" Ancillary Laboratory, Pathology, and Other Tests "	 Ancillary Imaging Services 	 Durable Medical Equipment and Supplies 	 Inpatient Hospital: Trigger 	 Inpatient Hospital: Readmission 	 Physician Services During Hospitalization 	 ER Evaluation & Management Services 	 ER Procedures 	" ER Laboratory, Pathology, and Other Tests "	ER Imaging Services	 Home Health 	 Skilled Nursing Facility 	 Inpatient Rehabilitation or Long-Term Care Hospital 	 Hospice   	 Ambulance Services 	 Chemotherapy and Other Part B-Covered Drugs 	 Dialysis 	All Other Services Not Otherwise Classified	
#	F	04/01/1939	#	#	#	Ted Jones	Cardiology	$	02/14/14	Name	CCN	City	State	481	Pneumococcal Pneumonia	03/01/14	3	Disch to SNF	$	$	$	$	$	$	$	$	$	$	$	$	$	$	$	$	$	$	$	$	$	$	
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* Refers to services in non-emergency settings.									* Refers to services in non-emergency settings.							* Refers to services in non-emergency settings.											* Refers to services in non-emergency settings.												* Refers to services in non-emergency settings.		
