| National Provider Identifier [NPI]: | 1336336155 |
| Last Name Of The Provider | DAVISON |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | F.N.P. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 810 MICHAEL DR STE K |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHESTERTON |
| Zip Code Of The Provider | 463042695 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 413 |
| Number Of Medicare Beneficiaries | 183 |
| Total Submitted Charge Amount | 37021.26 |
| Total Medicare Allowed Amount | 23057.75 |
| Total Medicare Payment Amount | 16649.1 |
| Total Medicare Standardized Payment Amount | 21309.8 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 40 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 837.26 |
| Total Drug Medicare AllowedAmount | 442.6 |
| Total Drug Medicare PaymentAmount | 426.53 |
| Total Drug Medicare Standardized Payment Amount | 426.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 373 |
| Number Of Medicare Beneficiaries With Medical Services | 183 |
| Total Medical Submitted Charge Amount | 36184 |
| Total Medical Medicare Allowed Amount | 22615.15 |
| Total Medical Medicare Payment Amount | 16222.57 |
| Total Medical Medicare Standardized Payment Amount | 20883.27 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 87 |
| Number Of Beneficiaries Age 75 to 84 | 53 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 126 |
| Number Of Male Beneficiaries | 57 |
| Number Of Non Hispanic White Beneficiaries | 171 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 159 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9116 |