| National Provider Identifier [NPI]: | 1255598629 |
| Last Name Of The Provider | MITRA |
| First Name Of The Provider | KATHRYN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | ACNP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2800 MAIN ST |
| Street Address 2 Of The Provider | ICU |
| City Of The Provider | BRIDGEPORT |
| Zip Code Of The Provider | 066064201 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 362 |
| Number Of Medicare Beneficiaries | 181 |
| Total Submitted Charge Amount | 131310 |
| Total Medicare Allowed Amount | 39342.38 |
| Total Medicare Payment Amount | 30728.04 |
| Total Medicare Standardized Payment Amount | 34069.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 362 |
| Number Of Medicare Beneficiaries With Medical Services | 181 |
| Total Medical Submitted Charge Amount | 131310 |
| Total Medical Medicare Allowed Amount | 39342.38 |
| Total Medical Medicare Payment Amount | 30728.04 |
| Total Medical Medicare Standardized Payment Amount | 34069.75 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 49 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 40 |
| Number Of Female Beneficiaries | 91 |
| Number Of Male Beneficiaries | 90 |
| Number Of Non Hispanic White Beneficiaries | 129 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 109 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 72 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 63 |
| Percent Of With Chronic Kidney Disease | 62 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 57 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 73 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 3.2329 |