| National Provider Identifier [NPI]: | 1609113133 |
| Last Name Of The Provider | DIALS |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | CCNS |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 578 N LEAVITT RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | AMHERST |
| Zip Code Of The Provider | 440011131 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Certified Clinical Nurse Specialist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 463 |
| Number Of Medicare Beneficiaries | 311 |
| Total Submitted Charge Amount | 107614 |
| Total Medicare Allowed Amount | 55198.41 |
| Total Medicare Payment Amount | 42700.92 |
| Total Medicare Standardized Payment Amount | 51257.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 463 |
| Number Of Medicare Beneficiaries With Medical Services | 311 |
| Total Medical Submitted Charge Amount | 107614 |
| Total Medical Medicare Allowed Amount | 55198.41 |
| Total Medical Medicare Payment Amount | 42700.92 |
| Total Medical Medicare Standardized Payment Amount | 51257.43 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 109 |
| Number Of Beneficiaries Age 75 to 84 | 90 |
| Number Of Beneficiaries Age Greater 84 | 72 |
| Number Of Female Beneficiaries | 182 |
| Number Of Male Beneficiaries | 129 |
| Number Of Non Hispanic White Beneficiaries | 295 |
| 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 | 240 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 71 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 63 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 2.1962 |