| National Provider Identifier [NPI]: | 1649429119 |
| Last Name Of The Provider | WILLIS |
| First Name Of The Provider | DAWNA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1910 NONCONNAH BLVD |
| Street Address 2 Of The Provider | SUITE 120 |
| City Of The Provider | MEMPHIS |
| Zip Code Of The Provider | 381322113 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 85 |
| Number Of Medicare Beneficiaries | 44 |
| Total Submitted Charge Amount | 3471.71 |
| Total Medicare Allowed Amount | 2694.26 |
| Total Medicare Payment Amount | 2278.54 |
| Total Medicare Standardized Payment Amount | 2761.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 29 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 1210.71 |
| Total Drug Medicare AllowedAmount | 1039.24 |
| Total Drug Medicare PaymentAmount | 1018.39 |
| Total Drug Medicare Standardized Payment Amount | 1018.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 11 |
| Number Of Medical Services | 56 |
| Number Of Medicare Beneficiaries With Medical Services | 44 |
| Total Medical Submitted Charge Amount | 2261 |
| Total Medical Medicare Allowed Amount | 1655.02 |
| Total Medical Medicare Payment Amount | 1260.15 |
| Total Medical Medicare Standardized Payment Amount | 1743.24 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 25 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 30 |
| Number Of Male Beneficiaries | 14 |
| 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 | |
| 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 | 30 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8412 |