| National Provider Identifier [NPI]: | 1619236908 |
| Last Name Of The Provider | BOLMER |
| First Name Of The Provider | JACQUELINE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | NP-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 210 STERLING RUN BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOUNT ORAB |
| Zip Code Of The Provider | 451548350 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 473 |
| Number Of Medicare Beneficiaries | 257 |
| Total Submitted Charge Amount | 27128 |
| Total Medicare Allowed Amount | 19755.45 |
| Total Medicare Payment Amount | 15307.96 |
| Total Medicare Standardized Payment Amount | 18027.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 108 |
| Number Of Medicare Beneficiaries With Drug Services | 102 |
| Total Drug Submitted ChargeAmount | 2755 |
| Total Drug Medicare AllowedAmount | 2069.37 |
| Total Drug Medicare PaymentAmount | 2027.95 |
| Total Drug Medicare Standardized Payment Amount | 2027.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 365 |
| Number Of Medicare Beneficiaries With Medical Services | 256 |
| Total Medical Submitted Charge Amount | 24373 |
| Total Medical Medicare Allowed Amount | 17686.08 |
| Total Medical Medicare Payment Amount | 13280.01 |
| Total Medical Medicare Standardized Payment Amount | 15999.15 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 130 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 169 |
| Number Of Male Beneficiaries | 88 |
| 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 | 221 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 36 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9009 |