| National Provider Identifier [NPI]: | 1154450484 |
| Last Name Of The Provider | BUSH |
| First Name Of The Provider | MICHELLE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | RN, MSN, CRNP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7073 CLYO ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CENTERVILLE |
| Zip Code Of The Provider | 45459 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 837 |
| Number Of Medicare Beneficiaries | 247 |
| Total Submitted Charge Amount | 100392.02 |
| Total Medicare Allowed Amount | 65503.87 |
| Total Medicare Payment Amount | 47706.94 |
| Total Medicare Standardized Payment Amount | 58218.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 18 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 470 |
| Total Drug Medicare AllowedAmount | 262.64 |
| Total Drug Medicare PaymentAmount | 257.4 |
| Total Drug Medicare Standardized Payment Amount | 257.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 819 |
| Number Of Medicare Beneficiaries With Medical Services | 247 |
| Total Medical Submitted Charge Amount | 99922.02 |
| Total Medical Medicare Allowed Amount | 65241.23 |
| Total Medical Medicare Payment Amount | 47449.54 |
| Total Medical Medicare Standardized Payment Amount | 57961.44 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 45 |
| Number Of Beneficiaries Age 75 to 84 | 57 |
| Number Of Beneficiaries Age Greater 84 | 86 |
| Number Of Female Beneficiaries | 161 |
| Number Of Male Beneficiaries | 86 |
| Number Of Non Hispanic White Beneficiaries | 209 |
| 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 | 118 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 129 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 41 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 49 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.3064 |