| National Provider Identifier [NPI]: | 1407867989 |
| Last Name Of The Provider | ODUM |
| First Name Of The Provider | JACQUELINE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | CNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2314 AUBURN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CINCINNATI |
| Zip Code Of The Provider | 452192802 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 1374 |
| Number Of Medicare Beneficiaries | 55 |
| Total Submitted Charge Amount | 17774.5 |
| Total Medicare Allowed Amount | 6176.31 |
| Total Medicare Payment Amount | 4380.34 |
| Total Medicare Standardized Payment Amount | 5588.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 1251 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 625.5 |
| Total Drug Medicare AllowedAmount | 209.06 |
| Total Drug Medicare PaymentAmount | 157.54 |
| Total Drug Medicare Standardized Payment Amount | 157.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 123 |
| Number Of Medicare Beneficiaries With Medical Services | 55 |
| Total Medical Submitted Charge Amount | 17149 |
| Total Medical Medicare Allowed Amount | 5967.25 |
| Total Medical Medicare Payment Amount | 4222.8 |
| Total Medical Medicare Standardized Payment Amount | 5431.16 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 24 |
| Number Of Beneficiaries Age 75 to 84 | 16 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 55 |
| Number Of Male Beneficiaries | 0 |
| 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 | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.513 |