| National Provider Identifier [NPI]: | 1568552487 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | F.N.P. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 126 MISSOURI AVE |
| Street Address 2 Of The Provider | MCXP-CCS-CR |
| City Of The Provider | FORT LEONARD WOOD |
| Zip Code Of The Provider | 654738952 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 7 |
| Number Of Services | 104 |
| Number Of Medicare Beneficiaries | 70 |
| Total Submitted Charge Amount | 4370 |
| Total Medicare Allowed Amount | 3608.98 |
| Total Medicare Payment Amount | 2165.29 |
| Total Medicare Standardized Payment Amount | 3185.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 12 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 208 |
| Total Drug Medicare AllowedAmount | 192.3 |
| Total Drug Medicare PaymentAmount | 188.44 |
| Total Drug Medicare Standardized Payment Amount | 188.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 5 |
| Number Of Medical Services | 92 |
| Number Of Medicare Beneficiaries With Medical Services | 70 |
| Total Medical Submitted Charge Amount | 4162 |
| Total Medical Medicare Allowed Amount | 3416.68 |
| Total Medical Medicare Payment Amount | 1976.85 |
| Total Medical Medicare Standardized Payment Amount | 2997.45 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 37 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 48 |
| Number Of Male Beneficiaries | 22 |
| 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 | 56 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 0 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | |
| 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 | 0.6943 |