| National Provider Identifier [NPI]: | 1083818553 |
| Last Name Of The Provider | NYSTROM |
| First Name Of The Provider | JACQUELYN |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9975 TAVISTOCK LAKE BLVD |
| Street Address 2 Of The Provider | SUITE 220 |
| City Of The Provider | ORLANDO |
| Zip Code Of The Provider | 328277559 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 84 |
| Number Of Services | 3311 |
| Number Of Medicare Beneficiaries | 333 |
| Total Submitted Charge Amount | 186626.5 |
| Total Medicare Allowed Amount | 123817.71 |
| Total Medicare Payment Amount | 90280.29 |
| Total Medicare Standardized Payment Amount | 90994.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 2005 |
| Number Of Medicare Beneficiaries With Drug Services | 77 |
| Total Drug Submitted ChargeAmount | 42913.5 |
| Total Drug Medicare AllowedAmount | 29877.29 |
| Total Drug Medicare PaymentAmount | 23854.8 |
| Total Drug Medicare Standardized Payment Amount | 23854.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 74 |
| Number Of Medical Services | 1306 |
| Number Of Medicare Beneficiaries With Medical Services | 333 |
| Total Medical Submitted Charge Amount | 143713 |
| Total Medical Medicare Allowed Amount | 93940.42 |
| Total Medical Medicare Payment Amount | 66425.49 |
| Total Medical Medicare Standardized Payment Amount | 67139.23 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 167 |
| Number Of Beneficiaries Age 75 to 84 | 97 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 225 |
| Number Of Male Beneficiaries | 108 |
| Number Of Non Hispanic White Beneficiaries | 318 |
| 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 | 313 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1257 |