| National Provider Identifier [NPI]: | 1649606310 |
| Last Name Of The Provider | BANIUKIEWICZ |
| First Name Of The Provider | ANN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | FNP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 26 QUEEN STREET |
| Street Address 2 Of The Provider | CREDENTIALING |
| City Of The Provider | WORCESTER |
| Zip Code Of The Provider | 016032034 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 217 |
| Number Of Medicare Beneficiaries | 119 |
| Total Submitted Charge Amount | 9441.3 |
| Total Medicare Allowed Amount | 8572.21 |
| Total Medicare Payment Amount | 7253.16 |
| Total Medicare Standardized Payment Amount | 8082.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 71 |
| Number Of Medicare Beneficiaries With Drug Services | 71 |
| Total Drug Submitted ChargeAmount | 2174.3 |
| Total Drug Medicare AllowedAmount | 2166.14 |
| Total Drug Medicare PaymentAmount | 2115.58 |
| Total Drug Medicare Standardized Payment Amount | 2115.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 146 |
| Number Of Medicare Beneficiaries With Medical Services | 119 |
| Total Medical Submitted Charge Amount | 7267 |
| Total Medical Medicare Allowed Amount | 6406.07 |
| Total Medical Medicare Payment Amount | 5137.58 |
| Total Medical Medicare Standardized Payment Amount | 5967.4 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 59 |
| Number Of Beneficiaries Age 75 to 84 | 32 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 74 |
| Number Of Male Beneficiaries | 45 |
| 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 | 96 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 45 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8402 |