| National Provider Identifier [NPI]: | 1225462500 |
| Last Name Of The Provider | TACY |
| First Name Of The Provider | REBECA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | APRN-NPC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 MEDICAL VILLAGE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | EDGEWOOD |
| Zip Code Of The Provider | 410173403 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 219 |
| Number Of Medicare Beneficiaries | 120 |
| Total Submitted Charge Amount | 11067 |
| Total Medicare Allowed Amount | 7958.34 |
| Total Medicare Payment Amount | 6143.46 |
| Total Medicare Standardized Payment Amount | 7357.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 60 |
| Number Of Medicare Beneficiaries With Drug Services | 57 |
| Total Drug Submitted ChargeAmount | 1110 |
| Total Drug Medicare AllowedAmount | 691.9 |
| Total Drug Medicare PaymentAmount | 676.55 |
| Total Drug Medicare Standardized Payment Amount | 676.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 159 |
| Number Of Medicare Beneficiaries With Medical Services | 120 |
| Total Medical Submitted Charge Amount | 9957 |
| Total Medical Medicare Allowed Amount | 7266.44 |
| Total Medical Medicare Payment Amount | 5466.91 |
| Total Medical Medicare Standardized Payment Amount | 6680.57 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 59 |
| Number Of Beneficiaries Age 75 to 84 | 32 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 72 |
| Number Of Male Beneficiaries | 48 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8751 |