| National Provider Identifier [NPI]: | 1023096492 |
| Last Name Of The Provider | KOUTS |
| First Name Of The Provider | HOLLY |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2720 LOGANVILLE HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOGANVILLE |
| Zip Code Of The Provider | 300527715 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 48 |
| Number Of Medicare Beneficiaries | 25 |
| Total Submitted Charge Amount | 2156.86 |
| Total Medicare Allowed Amount | 1810.04 |
| Total Medicare Payment Amount | 1430.07 |
| Total Medicare Standardized Payment Amount | 1628.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 14 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 519.86 |
| Total Drug Medicare AllowedAmount | 460.58 |
| Total Drug Medicare PaymentAmount | 451.37 |
| Total Drug Medicare Standardized Payment Amount | 451.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 34 |
| Number Of Medicare Beneficiaries With Medical Services | 25 |
| Total Medical Submitted Charge Amount | 1637 |
| Total Medical Medicare Allowed Amount | 1349.46 |
| Total Medical Medicare Payment Amount | 978.7 |
| Total Medical Medicare Standardized Payment Amount | 1176.72 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 14 |
| Number Of Male Beneficiaries | 11 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 0 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 0 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 0 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.6536 |