| National Provider Identifier [NPI]: | 1194158238 |
| Last Name Of The Provider | ALLEN |
| First Name Of The Provider | MIRJAM |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 N 1ST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627023719 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 1845 |
| Number Of Medicare Beneficiaries | 314 |
| Total Submitted Charge Amount | 122708.95 |
| Total Medicare Allowed Amount | 91618.87 |
| Total Medicare Payment Amount | 67609.89 |
| Total Medicare Standardized Payment Amount | 73630.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 843 |
| Number Of Medicare Beneficiaries With Drug Services | 191 |
| Total Drug Submitted ChargeAmount | 41456.53 |
| Total Drug Medicare AllowedAmount | 36563.53 |
| Total Drug Medicare PaymentAmount | 27547.22 |
| Total Drug Medicare Standardized Payment Amount | 27547.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 1002 |
| Number Of Medicare Beneficiaries With Medical Services | 314 |
| Total Medical Submitted Charge Amount | 81252.42 |
| Total Medical Medicare Allowed Amount | 55055.34 |
| Total Medical Medicare Payment Amount | 40062.67 |
| Total Medical Medicare Standardized Payment Amount | 46083.62 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 144 |
| Number Of Beneficiaries Age 75 to 84 | 93 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 187 |
| Number Of Male Beneficiaries | 127 |
| Number Of Non Hispanic White Beneficiaries | 292 |
| 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 | 263 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9609 |