| National Provider Identifier [NPI]: | 1679598791 |
| Last Name Of The Provider | PUCKETT |
| First Name Of The Provider | HEATHER |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | ANP-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 MEDICAL PARK DR STE 400 |
| Street Address 2 Of The Provider | |
| City Of The Provider | CONCORD |
| Zip Code Of The Provider | 280250906 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 2029 |
| Number Of Medicare Beneficiaries | 440 |
| Total Submitted Charge Amount | 356625 |
| Total Medicare Allowed Amount | 98890.53 |
| Total Medicare Payment Amount | 76114.57 |
| Total Medicare Standardized Payment Amount | 93386.78 |
| 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 | 34 |
| Number Of Medical Services | 2029 |
| Number Of Medicare Beneficiaries With Medical Services | 440 |
| Total Medical Submitted Charge Amount | 356625 |
| Total Medical Medicare Allowed Amount | 98890.53 |
| Total Medical Medicare Payment Amount | 76114.57 |
| Total Medical Medicare Standardized Payment Amount | 93386.78 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 137 |
| Number Of Beneficiaries Age 75 to 84 | 116 |
| Number Of Beneficiaries Age Greater 84 | 88 |
| Number Of Female Beneficiaries | 231 |
| Number Of Male Beneficiaries | 209 |
| Number Of Non Hispanic White Beneficiaries | 384 |
| 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 | 274 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 166 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 33 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 53 |
| Percent Of With Chronic Kidney Disease | 61 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 57 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 3.2211 |