| National Provider Identifier [NPI]: | 1346265923 |
| Last Name Of The Provider | GRIMES |
| First Name Of The Provider | GWENDOLYN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4801 VIRGINIA WOODS DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MCKINNEY |
| Zip Code Of The Provider | 750716459 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 2 |
| Number Of Services | 1025 |
| Number Of Medicare Beneficiaries | 232 |
| Total Submitted Charge Amount | 287775 |
| Total Medicare Allowed Amount | 69073.24 |
| Total Medicare Payment Amount | 54151.62 |
| Total Medicare Standardized Payment Amount | 65016.29 |
| 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 | 2 |
| Number Of Medical Services | 1025 |
| Number Of Medicare Beneficiaries With Medical Services | 232 |
| Total Medical Submitted Charge Amount | 287775 |
| Total Medical Medicare Allowed Amount | 69073.24 |
| Total Medical Medicare Payment Amount | 54151.62 |
| Total Medical Medicare Standardized Payment Amount | 65016.29 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 45 |
| Number Of Beneficiaries Age 75 to 84 | 81 |
| Number Of Beneficiaries Age Greater 84 | 88 |
| Number Of Female Beneficiaries | 160 |
| Number Of Male Beneficiaries | 72 |
| Number Of Non Hispanic White Beneficiaries | 197 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 168 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 64 |
| Percent Of With Atrial Fibrillation | 31 |
| Percent Of With Alzheimers Disease or Dementia | 58 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 59 |
| Percent Of With Chronic Kidney Disease | 63 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 64 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 65 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 20 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 2.3057 |