| National Provider Identifier [NPI]: | 1477500536 |
| Last Name Of The Provider | TANNER |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2021 KINGSLEY AVE |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | ORANGE PARK |
| Zip Code Of The Provider | 320735174 |
| 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 | 16 |
| Number Of Services | 107 |
| Number Of Medicare Beneficiaries | 70 |
| Total Submitted Charge Amount | 6155 |
| Total Medicare Allowed Amount | 4431.57 |
| Total Medicare Payment Amount | 3565.91 |
| Total Medicare Standardized Payment Amount | 3939.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 35 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 840 |
| Total Drug Medicare AllowedAmount | 582.11 |
| Total Drug Medicare PaymentAmount | 570.42 |
| Total Drug Medicare Standardized Payment Amount | 570.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 72 |
| Number Of Medicare Beneficiaries With Medical Services | 68 |
| Total Medical Submitted Charge Amount | 5315 |
| Total Medical Medicare Allowed Amount | 3849.46 |
| Total Medical Medicare Payment Amount | 2995.49 |
| Total Medical Medicare Standardized Payment Amount | 3369.44 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 41 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 38 |
| Number Of Male Beneficiaries | 32 |
| Number Of Non Hispanic White Beneficiaries | 59 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | |
| 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 | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 36 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.6293 |