| National Provider Identifier [NPI]: | 1194793711 |
| Last Name Of The Provider | LAWRENCE |
| First Name Of The Provider | ELAINE |
| 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 | 954 W STATE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SYCAMORE |
| Zip Code Of The Provider | 60178 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 390 |
| Number Of Medicare Beneficiaries | 147 |
| Total Submitted Charge Amount | 21406.5 |
| Total Medicare Allowed Amount | 17437.17 |
| Total Medicare Payment Amount | 11516.91 |
| Total Medicare Standardized Payment Amount | 14807.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 184.68 |
| Total Drug Medicare AllowedAmount | 179.51 |
| Total Drug Medicare PaymentAmount | 173.87 |
| Total Drug Medicare Standardized Payment Amount | 173.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 375 |
| Number Of Medicare Beneficiaries With Medical Services | 147 |
| Total Medical Submitted Charge Amount | 21221.82 |
| Total Medical Medicare Allowed Amount | 17257.66 |
| Total Medical Medicare Payment Amount | 11343.04 |
| Total Medical Medicare Standardized Payment Amount | 14633.84 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 75 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 108 |
| Number Of Male Beneficiaries | 39 |
| 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 | 131 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 16 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9264 |