| National Provider Identifier [NPI]: | 1790893147 |
| Last Name Of The Provider | RIVERA |
| First Name Of The Provider | ERIN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | PHD, CNS, APRN, BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 415 E COOK RD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468253636 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Certified Clinical Nurse Specialist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 1370 |
| Number Of Medicare Beneficiaries | 311 |
| Total Submitted Charge Amount | 174105.6 |
| Total Medicare Allowed Amount | 107608.86 |
| Total Medicare Payment Amount | 76921.1 |
| Total Medicare Standardized Payment Amount | 97855.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 1370 |
| Number Of Medicare Beneficiaries With Medical Services | 311 |
| Total Medical Submitted Charge Amount | 174105.6 |
| Total Medical Medicare Allowed Amount | 107608.86 |
| Total Medical Medicare Payment Amount | 76921.1 |
| Total Medical Medicare Standardized Payment Amount | 97855.95 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 134 |
| Number Of Beneficiaries Age 65 to 74 | 60 |
| Number Of Beneficiaries Age 75 to 84 | 54 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 184 |
| Number Of Male Beneficiaries | 127 |
| Number Of Non Hispanic White Beneficiaries | 284 |
| 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 | 85 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 226 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 59 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 57 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.7417 |