| National Provider Identifier [NPI]: | 1669782413 |
| Last Name Of The Provider | RIDER |
| First Name Of The Provider | NATHAN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | NURSE PRACTITIONER |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10 THOMAS HOLLOW RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LUCASVILLE |
| Zip Code Of The Provider | 456488889 |
| 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 | 23 |
| Number Of Services | 840 |
| Number Of Medicare Beneficiaries | 170 |
| Total Submitted Charge Amount | 88077 |
| Total Medicare Allowed Amount | 41694.56 |
| Total Medicare Payment Amount | 27324.81 |
| Total Medicare Standardized Payment Amount | 35268.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 63 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 656 |
| Total Drug Medicare AllowedAmount | 143.06 |
| Total Drug Medicare PaymentAmount | 85.04 |
| Total Drug Medicare Standardized Payment Amount | 85.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 777 |
| Number Of Medicare Beneficiaries With Medical Services | 170 |
| Total Medical Submitted Charge Amount | 87421 |
| Total Medical Medicare Allowed Amount | 41551.5 |
| Total Medical Medicare Payment Amount | 27239.77 |
| Total Medical Medicare Standardized Payment Amount | 35183.28 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 56 |
| Number Of Beneficiaries Age 65 to 74 | 73 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 86 |
| Number Of Male Beneficiaries | 84 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 87 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 83 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2384 |