| National Provider Identifier [NPI]: | 1780699132 |
| Last Name Of The Provider | HASENAUER |
| First Name Of The Provider | KELLEY |
| 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 | 810 W REID AVE |
| Street Address 2 Of The Provider | SUITE 4 |
| City Of The Provider | NORTH PLATTE |
| Zip Code Of The Provider | 691016583 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 828 |
| Number Of Medicare Beneficiaries | 91 |
| Total Submitted Charge Amount | 35697.23 |
| Total Medicare Allowed Amount | 14827.26 |
| Total Medicare Payment Amount | 10597.62 |
| Total Medicare Standardized Payment Amount | 13708.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 530 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 1374.95 |
| Total Drug Medicare AllowedAmount | 1189.08 |
| Total Drug Medicare PaymentAmount | 968.6 |
| Total Drug Medicare Standardized Payment Amount | 968.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 298 |
| Number Of Medicare Beneficiaries With Medical Services | 91 |
| Total Medical Submitted Charge Amount | 34322.28 |
| Total Medical Medicare Allowed Amount | 13638.18 |
| Total Medical Medicare Payment Amount | 9629.02 |
| Total Medical Medicare Standardized Payment Amount | 12740.25 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 52 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| 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 | 70 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7756 |