| National Provider Identifier [NPI]: | 1811138704 |
| Last Name Of The Provider | SAMO |
| First Name Of The Provider | LESLIE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2556 ENTERPRISE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ORANGE CITY |
| Zip Code Of The Provider | 327637939 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 205 |
| Number Of Medicare Beneficiaries | 108 |
| Total Submitted Charge Amount | 57683.2 |
| Total Medicare Allowed Amount | 12349.92 |
| Total Medicare Payment Amount | 8002.89 |
| Total Medicare Standardized Payment Amount | 9705.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 29 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 406.4 |
| Total Drug Medicare AllowedAmount | 46.53 |
| Total Drug Medicare PaymentAmount | 32.86 |
| Total Drug Medicare Standardized Payment Amount | 32.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 176 |
| Number Of Medicare Beneficiaries With Medical Services | 108 |
| Total Medical Submitted Charge Amount | 57276.8 |
| Total Medical Medicare Allowed Amount | 12303.39 |
| Total Medical Medicare Payment Amount | 7970.03 |
| Total Medical Medicare Standardized Payment Amount | 9672.81 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 52 |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 76 |
| Number Of Male Beneficiaries | 32 |
| Number Of Non Hispanic White Beneficiaries | 91 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.053 |