| National Provider Identifier [NPI]: | 1295701266 |
| Last Name Of The Provider | WILLIS |
| First Name Of The Provider | KERRY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | CRNP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 57 W JUNIPER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAZLETON |
| Zip Code Of The Provider | 182016410 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 964 |
| Number Of Medicare Beneficiaries | 815 |
| Total Submitted Charge Amount | 266288 |
| Total Medicare Allowed Amount | 87760.03 |
| Total Medicare Payment Amount | 65810.2 |
| Total Medicare Standardized Payment Amount | 78901.48 |
| 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 | 31 |
| Number Of Medical Services | 964 |
| Number Of Medicare Beneficiaries With Medical Services | 815 |
| Total Medical Submitted Charge Amount | 266288 |
| Total Medical Medicare Allowed Amount | 87760.03 |
| Total Medical Medicare Payment Amount | 65810.2 |
| Total Medical Medicare Standardized Payment Amount | 78901.48 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 216 |
| Number Of Beneficiaries Age 65 to 74 | 210 |
| Number Of Beneficiaries Age 75 to 84 | 210 |
| Number Of Beneficiaries Age Greater 84 | 179 |
| Number Of Female Beneficiaries | 490 |
| Number Of Male Beneficiaries | 325 |
| Number Of Non Hispanic White Beneficiaries | 701 |
| Number Of Black or African American Beneficiaries | 23 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 72 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 474 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 341 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.8215 |