| National Provider Identifier [NPI]: | 1285897652 |
| Last Name Of The Provider | WILBURN |
| First Name Of The Provider | CONNIE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 806 SEATON AVE |
| Street Address 2 Of The Provider | SUITE 1 |
| City Of The Provider | GREENUP |
| Zip Code Of The Provider | 411441196 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 4 |
| Number Of Services | 54 |
| Number Of Medicare Beneficiaries | 31 |
| Total Submitted Charge Amount | 1207.97 |
| Total Medicare Allowed Amount | 1158.71 |
| Total Medicare Payment Amount | 1135.54 |
| Total Medicare Standardized Payment Amount | 1242.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 25 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 452.62 |
| Total Drug Medicare AllowedAmount | 452.62 |
| Total Drug Medicare PaymentAmount | 443.55 |
| Total Drug Medicare Standardized Payment Amount | 443.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 2 |
| Number Of Medical Services | 29 |
| Number Of Medicare Beneficiaries With Medical Services | 28 |
| Total Medical Submitted Charge Amount | 755.35 |
| Total Medical Medicare Allowed Amount | 706.09 |
| Total Medical Medicare Payment Amount | 691.99 |
| Total Medical Medicare Standardized Payment Amount | 798.81 |
| Average Age Of Beneficiaries | 60 |
| Number Of Beneficiaries Age Less65 | 16 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 18 |
| Number Of Male Beneficiaries | 13 |
| Number Of Non Hispanic White Beneficiaries | 31 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 0 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 61 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.1978 |