| National Provider Identifier [NPI]: | 1780663005 |
| Last Name Of The Provider | HENRY |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 115 8TH ST NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CEDAR RAPIDS |
| Zip Code Of The Provider | 52401 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 1132 |
| Number Of Medicare Beneficiaries | 471 |
| Total Submitted Charge Amount | 137431 |
| Total Medicare Allowed Amount | 61282.52 |
| Total Medicare Payment Amount | 47632.83 |
| Total Medicare Standardized Payment Amount | 60091.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 35 |
| Number Of Medicare Beneficiaries With Drug Services | 32 |
| Total Drug Submitted ChargeAmount | 2165 |
| Total Drug Medicare AllowedAmount | 1632.28 |
| Total Drug Medicare PaymentAmount | 1599.54 |
| Total Drug Medicare Standardized Payment Amount | 1599.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 1097 |
| Number Of Medicare Beneficiaries With Medical Services | 471 |
| Total Medical Submitted Charge Amount | 135266 |
| Total Medical Medicare Allowed Amount | 59650.24 |
| Total Medical Medicare Payment Amount | 46033.29 |
| Total Medical Medicare Standardized Payment Amount | 58492.07 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 77 |
| Number Of Beneficiaries Age 65 to 74 | 165 |
| Number Of Beneficiaries Age 75 to 84 | 172 |
| Number Of Beneficiaries Age Greater 84 | 57 |
| Number Of Female Beneficiaries | 253 |
| Number Of Male Beneficiaries | 218 |
| Number Of Non Hispanic White Beneficiaries | 454 |
| 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 | 365 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 106 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 30 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 74 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 2.0917 |