| National Provider Identifier [NPI]: | 1679684252 |
| Last Name Of The Provider | RIDDELL |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8303 DODGE ST |
| Street Address 2 Of The Provider | #225 |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 68114 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 22209 |
| Number Of Medicare Beneficiaries | 108 |
| Total Submitted Charge Amount | 159555.38 |
| Total Medicare Allowed Amount | 124443.28 |
| Total Medicare Payment Amount | 95778.19 |
| Total Medicare Standardized Payment Amount | 99002.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 43 |
| Number Of Drug Services | 21773 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 131765.38 |
| Total Drug Medicare AllowedAmount | 105380.55 |
| Total Drug Medicare PaymentAmount | 81287.37 |
| Total Drug Medicare Standardized Payment Amount | 81287.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 436 |
| Number Of Medicare Beneficiaries With Medical Services | 108 |
| Total Medical Submitted Charge Amount | 27790 |
| Total Medical Medicare Allowed Amount | 19062.73 |
| Total Medical Medicare Payment Amount | 14490.82 |
| Total Medical Medicare Standardized Payment Amount | 17714.69 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 45 |
| Number Of Beneficiaries Age 75 to 84 | 36 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 67 |
| Number Of Male Beneficiaries | 41 |
| 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 | 94 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 52 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.0759 |