| National Provider Identifier [NPI]: | 1578738712 |
| Last Name Of The Provider | OEN |
| First Name Of The Provider | CONNIE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1005 BELLEFONTAINE AVE |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | LIMA |
| Zip Code Of The Provider | 458042851 |
| 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 | 23 |
| Number Of Services | 508 |
| Number Of Medicare Beneficiaries | 189 |
| Total Submitted Charge Amount | 49028 |
| Total Medicare Allowed Amount | 34696.85 |
| Total Medicare Payment Amount | 24809.97 |
| Total Medicare Standardized Payment Amount | 30863.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 52 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 1079 |
| Total Drug Medicare AllowedAmount | 418.8 |
| Total Drug Medicare PaymentAmount | 397.89 |
| Total Drug Medicare Standardized Payment Amount | 397.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 456 |
| Number Of Medicare Beneficiaries With Medical Services | 189 |
| Total Medical Submitted Charge Amount | 47949 |
| Total Medical Medicare Allowed Amount | 34278.05 |
| Total Medical Medicare Payment Amount | 24412.08 |
| Total Medical Medicare Standardized Payment Amount | 30465.85 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 74 |
| Number Of Beneficiaries Age 75 to 84 | 45 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 124 |
| Number Of Male Beneficiaries | 65 |
| Number Of Non Hispanic White Beneficiaries | 165 |
| 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 | 138 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1304 |