| National Provider Identifier [NPI]: | 1316290612 |
| Last Name Of The Provider | VATH |
| First Name Of The Provider | JACLYN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 104 N. MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CIMARRON |
| Zip Code Of The Provider | 678358819 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 323 |
| Number Of Medicare Beneficiaries | 65 |
| Total Submitted Charge Amount | 25168.75 |
| Total Medicare Allowed Amount | 10883.05 |
| Total Medicare Payment Amount | 7103.8 |
| Total Medicare Standardized Payment Amount | 9116.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 47 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 1055.75 |
| Total Drug Medicare AllowedAmount | 417.2 |
| Total Drug Medicare PaymentAmount | 355.77 |
| Total Drug Medicare Standardized Payment Amount | 355.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 276 |
| Number Of Medicare Beneficiaries With Medical Services | 65 |
| Total Medical Submitted Charge Amount | 24113 |
| Total Medical Medicare Allowed Amount | 10465.85 |
| Total Medical Medicare Payment Amount | 6748.03 |
| Total Medical Medicare Standardized Payment Amount | 8760.25 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 34 |
| Number Of Beneficiaries Age 75 to 84 | 17 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 45 |
| Number Of Male Beneficiaries | 20 |
| 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 | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7814 |