| National Provider Identifier [NPI]: | 1669498051 |
| Last Name Of The Provider | GRATZ |
| First Name Of The Provider | ADDIE |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 302 W MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | TISHOMINGO |
| Zip Code Of The Provider | 734601727 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 4463 |
| Number Of Medicare Beneficiaries | 120 |
| Total Submitted Charge Amount | 178057.01 |
| Total Medicare Allowed Amount | 80114.09 |
| Total Medicare Payment Amount | 55560.7 |
| Total Medicare Standardized Payment Amount | 69964.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 22 |
| Number Of Drug Services | 2559 |
| Number Of Medicare Beneficiaries With Drug Services | 97 |
| Total Drug Submitted ChargeAmount | 45689 |
| Total Drug Medicare AllowedAmount | 2040.86 |
| Total Drug Medicare PaymentAmount | 1474.37 |
| Total Drug Medicare Standardized Payment Amount | 1474.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 1904 |
| Number Of Medicare Beneficiaries With Medical Services | 120 |
| Total Medical Submitted Charge Amount | 132368.01 |
| Total Medical Medicare Allowed Amount | 78073.23 |
| Total Medical Medicare Payment Amount | 54086.33 |
| Total Medical Medicare Standardized Payment Amount | 68490.06 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 47 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 68 |
| Number Of Male Beneficiaries | 52 |
| Number Of Non Hispanic White Beneficiaries | 106 |
| 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 | 76 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 44 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0792 |