| National Provider Identifier [NPI]: | 1295893055 |
| Last Name Of The Provider | DERRICK |
| First Name Of The Provider | CAROLINE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | N.P. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 27901 WOODWARD AVE STE 300 |
| Street Address 2 Of The Provider | |
| City Of The Provider | BERKLEY |
| Zip Code Of The Provider | 480720921 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 6 |
| Number Of Services | 1217 |
| Number Of Medicare Beneficiaries | 530 |
| Total Submitted Charge Amount | 134131 |
| Total Medicare Allowed Amount | 86321.34 |
| Total Medicare Payment Amount | 67276.71 |
| Total Medicare Standardized Payment Amount | 77185.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 6 |
| Number Of Medical Services | 1217 |
| Number Of Medicare Beneficiaries With Medical Services | 530 |
| Total Medical Submitted Charge Amount | 134131 |
| Total Medical Medicare Allowed Amount | 86321.34 |
| Total Medical Medicare Payment Amount | 67276.71 |
| Total Medical Medicare Standardized Payment Amount | 77185.14 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 67 |
| Number Of Beneficiaries Age 65 to 74 | 141 |
| Number Of Beneficiaries Age 75 to 84 | 172 |
| Number Of Beneficiaries Age Greater 84 | 150 |
| Number Of Female Beneficiaries | 275 |
| Number Of Male Beneficiaries | 255 |
| Number Of Non Hispanic White Beneficiaries | 407 |
| Number Of Black or African American Beneficiaries | 85 |
| 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 | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 406 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 124 |
| Percent Of With Atrial Fibrillation | 51 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 22 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 70 |
| Percent Of With Chronic Kidney Disease | 66 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 42 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 22 |
| Average HCC Risk Score Of Beneficiaries | 2.9127 |