| National Provider Identifier [NPI]: | 1003069709 |
| Last Name Of The Provider | SERVELLON |
| First Name Of The Provider | ANNAMARIA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | FNP-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 75 N COUNTRY RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORT JEFFERSON |
| Zip Code Of The Provider | 117772119 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 274 |
| Number Of Medicare Beneficiaries | 79 |
| Total Submitted Charge Amount | 38446.41 |
| Total Medicare Allowed Amount | 19230.16 |
| Total Medicare Payment Amount | 14962.41 |
| Total Medicare Standardized Payment Amount | 15481.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 37 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 925 |
| Total Drug Medicare AllowedAmount | 118.49 |
| Total Drug Medicare PaymentAmount | 92.91 |
| Total Drug Medicare Standardized Payment Amount | 92.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 237 |
| Number Of Medicare Beneficiaries With Medical Services | 79 |
| Total Medical Submitted Charge Amount | 37521.41 |
| Total Medical Medicare Allowed Amount | 19111.67 |
| Total Medical Medicare Payment Amount | 14869.5 |
| Total Medical Medicare Standardized Payment Amount | 15389.03 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 25 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 41 |
| Number Of Male Beneficiaries | 38 |
| Number Of Non Hispanic White Beneficiaries | 67 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 51 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 49 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.6399 |