| National Provider Identifier [NPI]: | 1023195286 |
| Last Name Of The Provider | PAYNE |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2850 S INDUSTRIAL HWY |
| Street Address 2 Of The Provider | #75 |
| City Of The Provider | ANN ARBOR |
| Zip Code Of The Provider | 481046796 |
| 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 | 17 |
| Number Of Services | 349 |
| Number Of Medicare Beneficiaries | 50 |
| Total Submitted Charge Amount | 95143 |
| Total Medicare Allowed Amount | 39772.84 |
| Total Medicare Payment Amount | 29804.91 |
| Total Medicare Standardized Payment Amount | 33828.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 868 |
| Total Drug Medicare AllowedAmount | 532.34 |
| Total Drug Medicare PaymentAmount | 521.66 |
| Total Drug Medicare Standardized Payment Amount | 521.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 334 |
| Number Of Medicare Beneficiaries With Medical Services | 50 |
| Total Medical Submitted Charge Amount | 94275 |
| Total Medical Medicare Allowed Amount | 39240.5 |
| Total Medical Medicare Payment Amount | 29283.25 |
| Total Medical Medicare Standardized Payment Amount | 33306.64 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 11 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 37 |
| Number Of Male Beneficiaries | 13 |
| Number Of Non Hispanic White Beneficiaries | 31 |
| 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 | 22 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 46 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 22 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.7944 |