| National Provider Identifier [NPI]: | 1174521702 |
| Last Name Of The Provider | STARK |
| First Name Of The Provider | CHARLOTTE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 704 EDWARDS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WESTCLIFFE |
| Zip Code Of The Provider | 812528588 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 104 |
| Number Of Services | 2085 |
| Number Of Medicare Beneficiaries | 393 |
| Total Submitted Charge Amount | 194025.5 |
| Total Medicare Allowed Amount | 74365.36 |
| Total Medicare Payment Amount | 54831.63 |
| Total Medicare Standardized Payment Amount | 64856.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 380 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 617.5 |
| Total Drug Medicare AllowedAmount | 178.66 |
| Total Drug Medicare PaymentAmount | 137.65 |
| Total Drug Medicare Standardized Payment Amount | 137.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 1705 |
| Number Of Medicare Beneficiaries With Medical Services | 393 |
| Total Medical Submitted Charge Amount | 193408 |
| Total Medical Medicare Allowed Amount | 74186.7 |
| Total Medical Medicare Payment Amount | 54693.98 |
| Total Medical Medicare Standardized Payment Amount | 64718.81 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 203 |
| Number Of Beneficiaries Age 75 to 84 | 111 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 210 |
| Number Of Male Beneficiaries | 183 |
| Number Of Non Hispanic White Beneficiaries | 380 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 351 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 13 |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8195 |