| National Provider Identifier [NPI]: | 1144313982 |
| Last Name Of The Provider | NOLEN |
| First Name Of The Provider | ANN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7600 HIGHWAY 29 W |
| Street Address 2 Of The Provider | SUITE 5 |
| City Of The Provider | GEORGETOWN |
| Zip Code Of The Provider | 786286937 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 100 |
| Number Of Medicare Beneficiaries | 52 |
| Total Submitted Charge Amount | 2965.88 |
| Total Medicare Allowed Amount | 2707.05 |
| Total Medicare Payment Amount | 2117.66 |
| Total Medicare Standardized Payment Amount | 2151.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 328.18 |
| Total Drug Medicare AllowedAmount | 286.74 |
| Total Drug Medicare PaymentAmount | 223.29 |
| Total Drug Medicare Standardized Payment Amount | 223.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 85 |
| Number Of Medicare Beneficiaries With Medical Services | 52 |
| Total Medical Submitted Charge Amount | 2637.7 |
| Total Medical Medicare Allowed Amount | 2420.31 |
| Total Medical Medicare Payment Amount | 1894.37 |
| Total Medical Medicare Standardized Payment Amount | 1927.82 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | 0 |
| Number Of Female Beneficiaries | 16 |
| Number Of Male Beneficiaries | 36 |
| 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 | 0 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 0 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 35 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 31 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.5432 |