| National Provider Identifier [NPI]: | 1407056013 |
| Last Name Of The Provider | FERGUSON |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | NP-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4069 LAKE DR SE |
| Street Address 2 Of The Provider | SUITE 315 |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 495468816 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 69 |
| Number Of Medicare Beneficiaries | 36 |
| Total Submitted Charge Amount | 7330 |
| Total Medicare Allowed Amount | 3413.43 |
| Total Medicare Payment Amount | 2345.6 |
| Total Medicare Standardized Payment Amount | 2922.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 11 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 143 |
| Total Drug Medicare AllowedAmount | 143 |
| Total Drug Medicare PaymentAmount | 140.14 |
| Total Drug Medicare Standardized Payment Amount | 140.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 58 |
| Number Of Medicare Beneficiaries With Medical Services | 36 |
| Total Medical Submitted Charge Amount | 7187 |
| Total Medical Medicare Allowed Amount | 3270.43 |
| Total Medical Medicare Payment Amount | 2205.46 |
| Total Medical Medicare Standardized Payment Amount | 2782.78 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 24 |
| Number Of Male Beneficiaries | 12 |
| 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 | 33 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.0742 |