| National Provider Identifier [NPI]: | 1245228485 |
| Last Name Of The Provider | JAQUISH |
| First Name Of The Provider | KIM |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | RNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1500 DODSON AVE |
| Street Address 2 Of The Provider | STE 125 |
| City Of The Provider | FORT SMITH |
| Zip Code Of The Provider | 729015182 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 1174 |
| Number Of Medicare Beneficiaries | 446 |
| Total Submitted Charge Amount | 177155 |
| Total Medicare Allowed Amount | 54442.07 |
| Total Medicare Payment Amount | 36864.67 |
| Total Medicare Standardized Payment Amount | 44835.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 68 |
| Number Of Medicare Beneficiaries With Drug Services | 66 |
| Total Drug Submitted ChargeAmount | 3143 |
| Total Drug Medicare AllowedAmount | 1009.23 |
| Total Drug Medicare PaymentAmount | 989.09 |
| Total Drug Medicare Standardized Payment Amount | 989.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 1106 |
| Number Of Medicare Beneficiaries With Medical Services | 446 |
| Total Medical Submitted Charge Amount | 174012 |
| Total Medical Medicare Allowed Amount | 53432.84 |
| Total Medical Medicare Payment Amount | 35875.58 |
| Total Medical Medicare Standardized Payment Amount | 43845.95 |
| Average Age Of Beneficiaries | 83 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 173 |
| Number Of Beneficiaries Age Greater 84 | 199 |
| Number Of Female Beneficiaries | 361 |
| Number Of Male Beneficiaries | 85 |
| Number Of Non Hispanic White Beneficiaries | 414 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 17 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 357 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 89 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 37 |
| Percent Of With Asthma | 2 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2806 |