| National Provider Identifier [NPI]: | 1821284266 |
| Last Name Of The Provider | SELF |
| First Name Of The Provider | ANN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | FNP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 301 N 8TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627011041 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 913 |
| Number Of Medicare Beneficiaries | 283 |
| Total Submitted Charge Amount | 56627.48 |
| Total Medicare Allowed Amount | 43452.43 |
| Total Medicare Payment Amount | 31423.58 |
| Total Medicare Standardized Payment Amount | 38877.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 296 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 1918.23 |
| Total Drug Medicare AllowedAmount | 1786.31 |
| Total Drug Medicare PaymentAmount | 1577.97 |
| Total Drug Medicare Standardized Payment Amount | 1577.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 617 |
| Number Of Medicare Beneficiaries With Medical Services | 283 |
| Total Medical Submitted Charge Amount | 54709.25 |
| Total Medical Medicare Allowed Amount | 41666.12 |
| Total Medical Medicare Payment Amount | 29845.61 |
| Total Medical Medicare Standardized Payment Amount | 37299.88 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 149 |
| Number Of Beneficiaries Age 75 to 84 | 71 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 143 |
| Number Of Male Beneficiaries | 140 |
| Number Of Non Hispanic White Beneficiaries | 257 |
| 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 | 229 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2862 |