| National Provider Identifier [NPI]: | 1952651556 |
| Last Name Of The Provider | DOUGHERTY |
| First Name Of The Provider | CAITLIN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | CRNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 WALNUT ST |
| Street Address 2 Of The Provider | 17TH FLOOR |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191075176 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 391 |
| Number Of Medicare Beneficiaries | 216 |
| Total Submitted Charge Amount | 14493.47 |
| Total Medicare Allowed Amount | 13739.38 |
| Total Medicare Payment Amount | 11218.95 |
| Total Medicare Standardized Payment Amount | 12518.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 154 |
| Number Of Medicare Beneficiaries With Drug Services | 151 |
| Total Drug Submitted ChargeAmount | 4702.47 |
| Total Drug Medicare AllowedAmount | 4643.19 |
| Total Drug Medicare PaymentAmount | 4550.1 |
| Total Drug Medicare Standardized Payment Amount | 4550.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 237 |
| Number Of Medicare Beneficiaries With Medical Services | 216 |
| Total Medical Submitted Charge Amount | 9791 |
| Total Medical Medicare Allowed Amount | 9096.19 |
| Total Medical Medicare Payment Amount | 6668.85 |
| Total Medical Medicare Standardized Payment Amount | 7968.23 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 118 |
| Number Of Beneficiaries Age 75 to 84 | 72 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 131 |
| Number Of Male Beneficiaries | 85 |
| Number Of Non Hispanic White Beneficiaries | 194 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| 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 | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 9 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8004 |