| National Provider Identifier [NPI]: | 1356578348 |
| Last Name Of The Provider | COLLIE-MICKENS |
| First Name Of The Provider | ELIZABETH |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2862 NW SUWANNEE VALLEY RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKE CITY |
| Zip Code Of The Provider | 320555603 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 1824 |
| Number Of Medicare Beneficiaries | 612 |
| Total Submitted Charge Amount | 401982.02 |
| Total Medicare Allowed Amount | 146795.22 |
| Total Medicare Payment Amount | 114073.08 |
| Total Medicare Standardized Payment Amount | 132678.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 1824 |
| Number Of Medicare Beneficiaries With Medical Services | 612 |
| Total Medical Submitted Charge Amount | 401982.02 |
| Total Medical Medicare Allowed Amount | 146795.22 |
| Total Medical Medicare Payment Amount | 114073.08 |
| Total Medical Medicare Standardized Payment Amount | 132678.12 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 248 |
| Number Of Beneficiaries Age 65 to 74 | 121 |
| Number Of Beneficiaries Age 75 to 84 | 109 |
| Number Of Beneficiaries Age Greater 84 | 134 |
| Number Of Female Beneficiaries | 346 |
| Number Of Male Beneficiaries | 266 |
| Number Of Non Hispanic White Beneficiaries | 481 |
| Number Of Black or African American Beneficiaries | 73 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 46 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 245 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 367 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 45 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 39 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.9658 |