| National Provider Identifier [NPI]: | 1528400710 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 560 S LOOP RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | EDGEWOOD |
| Zip Code Of The Provider | 410173405 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 1075 |
| Number Of Medicare Beneficiaries | 155 |
| Total Submitted Charge Amount | 176864 |
| Total Medicare Allowed Amount | 141833.72 |
| Total Medicare Payment Amount | 110804.13 |
| Total Medicare Standardized Payment Amount | 136633.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 32 |
| Number Of Medicare Beneficiaries With Drug Services | 32 |
| Total Drug Submitted ChargeAmount | 1425 |
| Total Drug Medicare AllowedAmount | 821.63 |
| Total Drug Medicare PaymentAmount | 805.16 |
| Total Drug Medicare Standardized Payment Amount | 805.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 1043 |
| Number Of Medicare Beneficiaries With Medical Services | 155 |
| Total Medical Submitted Charge Amount | 175439 |
| Total Medical Medicare Allowed Amount | 141012.09 |
| Total Medical Medicare Payment Amount | 109998.97 |
| Total Medical Medicare Standardized Payment Amount | 135828.65 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 44 |
| Number Of Beneficiaries Age 75 to 84 | 34 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 55 |
| 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 | 90 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 65 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 35 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 48 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 63 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 64 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.968 |