| National Provider Identifier [NPI]: | 1013168715 |
| Last Name Of The Provider | FAULCONER |
| First Name Of The Provider | VICTORIA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 989 GOVERNORS LN STE 180 |
| Street Address 2 Of The Provider | |
| City Of The Provider | LEXINGTON |
| Zip Code Of The Provider | 405131174 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 3154 |
| Number Of Medicare Beneficiaries | 505 |
| Total Submitted Charge Amount | 259901 |
| Total Medicare Allowed Amount | 135680.47 |
| Total Medicare Payment Amount | 98451.93 |
| Total Medicare Standardized Payment Amount | 124497.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 39 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 156 |
| Total Drug Medicare AllowedAmount | 69.3 |
| Total Drug Medicare PaymentAmount | 51.49 |
| Total Drug Medicare Standardized Payment Amount | 51.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 3115 |
| Number Of Medicare Beneficiaries With Medical Services | 505 |
| Total Medical Submitted Charge Amount | 259745 |
| Total Medical Medicare Allowed Amount | 135611.17 |
| Total Medical Medicare Payment Amount | 98400.44 |
| Total Medical Medicare Standardized Payment Amount | 124446.46 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 239 |
| Number Of Beneficiaries Age 75 to 84 | 139 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 286 |
| Number Of Male Beneficiaries | 219 |
| Number Of Non Hispanic White Beneficiaries | 485 |
| 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 | 457 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 48 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0139 |