| National Provider Identifier [NPI]: | 1053479337 |
| Last Name Of The Provider | PETTY |
| First Name Of The Provider | CINDY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | NP-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4710 EVERHART RD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | CORPUS CHRISTI |
| Zip Code Of The Provider | 784112750 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 733 |
| Number Of Medicare Beneficiaries | 53 |
| Total Submitted Charge Amount | 51611.5 |
| Total Medicare Allowed Amount | 22424.32 |
| Total Medicare Payment Amount | 15986.38 |
| Total Medicare Standardized Payment Amount | 19896.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 362 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 1427.5 |
| Total Drug Medicare AllowedAmount | 106.52 |
| Total Drug Medicare PaymentAmount | 80.73 |
| Total Drug Medicare Standardized Payment Amount | 80.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 371 |
| Number Of Medicare Beneficiaries With Medical Services | 53 |
| Total Medical Submitted Charge Amount | 50184 |
| Total Medical Medicare Allowed Amount | 22317.8 |
| Total Medical Medicare Payment Amount | 15905.65 |
| Total Medical Medicare Standardized Payment Amount | 19815.82 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 15 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 32 |
| Number Of Male Beneficiaries | 21 |
| Number Of Non Hispanic White Beneficiaries | 27 |
| 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 | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9996 |