| National Provider Identifier [NPI]: | 1346248754 |
| Last Name Of The Provider | HANISCH |
| First Name Of The Provider | ELLEN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | NURSE PRACTITIONER |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11511 CANTERWOOD BLVD |
| Street Address 2 Of The Provider | SUITE 45 |
| City Of The Provider | GIG HARBOR |
| Zip Code Of The Provider | 983325813 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 127 |
| Number Of Services | 64329 |
| Number Of Medicare Beneficiaries | 568 |
| Total Submitted Charge Amount | 2019811.6 |
| Total Medicare Allowed Amount | 1042264.65 |
| Total Medicare Payment Amount | 813045.29 |
| Total Medicare Standardized Payment Amount | 831964.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 65 |
| Number Of Drug Services | 60489 |
| Number Of Medicare Beneficiaries With Drug Services | 210 |
| Total Drug Submitted ChargeAmount | 1625662 |
| Total Drug Medicare AllowedAmount | 877080.07 |
| Total Drug Medicare PaymentAmount | 685977.9 |
| Total Drug Medicare Standardized Payment Amount | 685977.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 3840 |
| Number Of Medicare Beneficiaries With Medical Services | 568 |
| Total Medical Submitted Charge Amount | 394149.6 |
| Total Medical Medicare Allowed Amount | 165184.58 |
| Total Medical Medicare Payment Amount | 127067.39 |
| Total Medical Medicare Standardized Payment Amount | 145987.01 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 252 |
| Number Of Beneficiaries Age 75 to 84 | 195 |
| Number Of Beneficiaries Age Greater 84 | 78 |
| Number Of Female Beneficiaries | 339 |
| Number Of Male Beneficiaries | 229 |
| Number Of Non Hispanic White Beneficiaries | 531 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| 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 | 516 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 44 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.9054 |