| National Provider Identifier [NPI]: | 1114163136 |
| Last Name Of The Provider | JUSTICE |
| First Name Of The Provider | HEIDI |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 912 WALLACE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LEITCHFIELD |
| Zip Code Of The Provider | 427542404 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 767 |
| Number Of Medicare Beneficiaries | 253 |
| Total Submitted Charge Amount | 39849.98 |
| Total Medicare Allowed Amount | 23139.63 |
| Total Medicare Payment Amount | 14367.57 |
| Total Medicare Standardized Payment Amount | 19758.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 369 |
| Number Of Medicare Beneficiaries With Drug Services | 85 |
| Total Drug Submitted ChargeAmount | 1686.98 |
| Total Drug Medicare AllowedAmount | 382.39 |
| Total Drug Medicare PaymentAmount | 282.18 |
| Total Drug Medicare Standardized Payment Amount | 282.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 398 |
| Number Of Medicare Beneficiaries With Medical Services | 253 |
| Total Medical Submitted Charge Amount | 38163 |
| Total Medical Medicare Allowed Amount | 22757.24 |
| Total Medical Medicare Payment Amount | 14085.39 |
| Total Medical Medicare Standardized Payment Amount | 19476.09 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 60 |
| Number Of Beneficiaries Age 65 to 74 | 120 |
| Number Of Beneficiaries Age 75 to 84 | 61 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 157 |
| Number Of Male Beneficiaries | 96 |
| 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 | 214 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8079 |