| National Provider Identifier [NPI]: | 1912130048 |
| Last Name Of The Provider | TACKETT |
| First Name Of The Provider | CATHY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1901 ARGONNE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORTSMOUTH |
| Zip Code Of The Provider | 456622827 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 944 |
| Number Of Medicare Beneficiaries | 377 |
| Total Submitted Charge Amount | 127144.13 |
| Total Medicare Allowed Amount | 41367.86 |
| Total Medicare Payment Amount | 28547.4 |
| Total Medicare Standardized Payment Amount | 35605.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 17 |
| Number Of Drug Services | 444 |
| Number Of Medicare Beneficiaries With Drug Services | 115 |
| Total Drug Submitted ChargeAmount | 9389.13 |
| Total Drug Medicare AllowedAmount | 375.78 |
| Total Drug Medicare PaymentAmount | 272.03 |
| Total Drug Medicare Standardized Payment Amount | 272.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 500 |
| Number Of Medicare Beneficiaries With Medical Services | 377 |
| Total Medical Submitted Charge Amount | 117755 |
| Total Medical Medicare Allowed Amount | 40992.08 |
| Total Medical Medicare Payment Amount | 28275.37 |
| Total Medical Medicare Standardized Payment Amount | 35333.29 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 171 |
| Number Of Beneficiaries Age 65 to 74 | 123 |
| Number Of Beneficiaries Age 75 to 84 | 57 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 217 |
| Number Of Male Beneficiaries | 160 |
| 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 | 190 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 187 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1835 |