| National Provider Identifier [NPI]: | 1942536883 |
| Last Name Of The Provider | COFFMAN |
| First Name Of The Provider | JACQUELINE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 144 DETTRO DRIVE |
| Street Address 2 Of The Provider | SBL WALK-IN CLINIC |
| City Of The Provider | MATTOON |
| Zip Code Of The Provider | 61938 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 362 |
| Number Of Medicare Beneficiaries | 192 |
| Total Submitted Charge Amount | 26048 |
| Total Medicare Allowed Amount | 16335.63 |
| Total Medicare Payment Amount | 11520.61 |
| Total Medicare Standardized Payment Amount | 14377.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 80 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 1694 |
| Total Drug Medicare AllowedAmount | 401.01 |
| Total Drug Medicare PaymentAmount | 288.06 |
| Total Drug Medicare Standardized Payment Amount | 288.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 282 |
| Number Of Medicare Beneficiaries With Medical Services | 192 |
| Total Medical Submitted Charge Amount | 24354 |
| Total Medical Medicare Allowed Amount | 15934.62 |
| Total Medical Medicare Payment Amount | 11232.55 |
| Total Medical Medicare Standardized Payment Amount | 14089.91 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 72 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 124 |
| Number Of Male Beneficiaries | 68 |
| 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 | 131 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1024 |