| National Provider Identifier [NPI]: | 1316293350 |
| Last Name Of The Provider | STEGALL |
| First Name Of The Provider | CAROLYN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3145 PEACHTREE RD NE |
| Street Address 2 Of The Provider | #165 |
| City Of The Provider | ATLANTA |
| Zip Code Of The Provider | 303051800 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 7 |
| Number Of Services | 1558 |
| Number Of Medicare Beneficiaries | 19 |
| Total Submitted Charge Amount | 46917 |
| Total Medicare Allowed Amount | 38795.2 |
| Total Medicare Payment Amount | 28931.04 |
| Total Medicare Standardized Payment Amount | 33545.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 988 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 6225 |
| Total Drug Medicare AllowedAmount | 4955.5 |
| Total Drug Medicare PaymentAmount | 3745.23 |
| Total Drug Medicare Standardized Payment Amount | 3745.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 4 |
| Number Of Medical Services | 570 |
| Number Of Medicare Beneficiaries With Medical Services | 19 |
| Total Medical Submitted Charge Amount | 40692 |
| Total Medical Medicare Allowed Amount | 33839.7 |
| Total Medical Medicare Payment Amount | 25185.81 |
| Total Medical Medicare Standardized Payment Amount | 29800.75 |
| Average Age Of Beneficiaries | 59 |
| 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 | 0 |
| Number Of Female Beneficiaries | 0 |
| Number Of Male Beneficiaries | 19 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 0 |
| Percent Of With Alzheimers Disease or Dementia | 0 |
| Percent Of With Asthma | 0 |
| Percent Of With Cancer | 0 |
| Percent Of With Heart Failure | 0 |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 0 |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0897 |