| National Provider Identifier [NPI]: | 1215915277 |
| Last Name Of The Provider | KEY |
| First Name Of The Provider | DAWN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MSN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 624 W MARTIN LUTHER KING JR DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MILLEDGEVILLE |
| Zip Code Of The Provider | 310612787 |
| 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 | 91 |
| Number Of Services | 41743 |
| Number Of Medicare Beneficiaries | 329 |
| Total Submitted Charge Amount | 1615610 |
| Total Medicare Allowed Amount | 535136.63 |
| Total Medicare Payment Amount | 418839.62 |
| Total Medicare Standardized Payment Amount | 429120.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 55 |
| Number Of Drug Services | 39499 |
| Number Of Medicare Beneficiaries With Drug Services | 145 |
| Total Drug Submitted ChargeAmount | 1350993 |
| Total Drug Medicare AllowedAmount | 465691.57 |
| Total Drug Medicare PaymentAmount | 364868.12 |
| Total Drug Medicare Standardized Payment Amount | 364868.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 2244 |
| Number Of Medicare Beneficiaries With Medical Services | 329 |
| Total Medical Submitted Charge Amount | 264617 |
| Total Medical Medicare Allowed Amount | 69445.06 |
| Total Medical Medicare Payment Amount | 53971.5 |
| Total Medical Medicare Standardized Payment Amount | 64251.94 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 169 |
| Number Of Beneficiaries Age 75 to 84 | 104 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 257 |
| Number Of Male Beneficiaries | 72 |
| Number Of Non Hispanic White Beneficiaries | 272 |
| 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 | 296 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 65 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5801 |