| National Provider Identifier [NPI]: | 1184936627 |
| Last Name Of The Provider | NEDOM |
| First Name Of The Provider | JESSICA |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2930 11TH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | EVANS |
| Zip Code Of The Provider | 806201011 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 1166 |
| Number Of Medicare Beneficiaries | 599 |
| Total Submitted Charge Amount | 124709.6 |
| Total Medicare Allowed Amount | 73762.58 |
| Total Medicare Payment Amount | 50895.67 |
| Total Medicare Standardized Payment Amount | 60851.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 63 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 2762.6 |
| Total Drug Medicare AllowedAmount | 1886.91 |
| Total Drug Medicare PaymentAmount | 1846.56 |
| Total Drug Medicare Standardized Payment Amount | 1846.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 1103 |
| Number Of Medicare Beneficiaries With Medical Services | 599 |
| Total Medical Submitted Charge Amount | 121947 |
| Total Medical Medicare Allowed Amount | 71875.67 |
| Total Medical Medicare Payment Amount | 49049.11 |
| Total Medical Medicare Standardized Payment Amount | 59005.25 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 209 |
| Number Of Beneficiaries Age 75 to 84 | 209 |
| Number Of Beneficiaries Age Greater 84 | 149 |
| Number Of Female Beneficiaries | 393 |
| Number Of Male Beneficiaries | 206 |
| Number Of Non Hispanic White Beneficiaries | 576 |
| 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 | 543 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 56 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0811 |