| National Provider Identifier [NPI]: | 1902804297 |
| Last Name Of The Provider | WITT |
| First Name Of The Provider | CONNIE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | FNP-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2968 HIGHWAY 337 |
| Street Address 2 Of The Provider | |
| City Of The Provider | MENLO |
| Zip Code Of The Provider | 30731 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 1311 |
| Number Of Medicare Beneficiaries | 337 |
| Total Submitted Charge Amount | 119677 |
| Total Medicare Allowed Amount | 45988.92 |
| Total Medicare Payment Amount | 28434.78 |
| Total Medicare Standardized Payment Amount | 35977.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 18 |
| Number Of Drug Services | 473 |
| Number Of Medicare Beneficiaries With Drug Services | 112 |
| Total Drug Submitted ChargeAmount | 8548 |
| Total Drug Medicare AllowedAmount | 906.6 |
| Total Drug Medicare PaymentAmount | 694 |
| Total Drug Medicare Standardized Payment Amount | 694 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 838 |
| Number Of Medicare Beneficiaries With Medical Services | 337 |
| Total Medical Submitted Charge Amount | 111129 |
| Total Medical Medicare Allowed Amount | 45082.32 |
| Total Medical Medicare Payment Amount | 27740.78 |
| Total Medical Medicare Standardized Payment Amount | 35283.86 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 119 |
| Number Of Beneficiaries Age 65 to 74 | 124 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 206 |
| Number Of Male Beneficiaries | 131 |
| Number Of Non Hispanic White Beneficiaries | 314 |
| 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 | 174 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 163 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.3907 |