| National Provider Identifier [NPI]: | 1669679114 |
| Last Name Of The Provider | ENNIS |
| First Name Of The Provider | ERIN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 801 POOLE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | GARNER |
| Zip Code Of The Provider | 275295207 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 74 |
| Number Of Services | 1768 |
| Number Of Medicare Beneficiaries | 160 |
| Total Submitted Charge Amount | 140344 |
| Total Medicare Allowed Amount | 57477.56 |
| Total Medicare Payment Amount | 42892.85 |
| Total Medicare Standardized Payment Amount | 44768.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 348 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 16795 |
| Total Drug Medicare AllowedAmount | 8551.53 |
| Total Drug Medicare PaymentAmount | 7379.62 |
| Total Drug Medicare Standardized Payment Amount | 7379.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 1420 |
| Number Of Medicare Beneficiaries With Medical Services | 160 |
| Total Medical Submitted Charge Amount | 123549 |
| Total Medical Medicare Allowed Amount | 48926.03 |
| Total Medical Medicare Payment Amount | 35513.23 |
| Total Medical Medicare Standardized Payment Amount | 37388.64 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 89 |
| Number Of Beneficiaries Age 75 to 84 | 36 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 121 |
| Number Of Male Beneficiaries | 39 |
| Number Of Non Hispanic White Beneficiaries | 143 |
| 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 | 148 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8487 |