| National Provider Identifier [NPI]: | 1942407069 |
| Last Name Of The Provider | VETAL |
| First Name Of The Provider | KIMBERLY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | F.N.P. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 255 E OLD STURBRIDGE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BRIMFIELD |
| Zip Code Of The Provider | 010109647 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 522 |
| Number Of Medicare Beneficiaries | 164 |
| Total Submitted Charge Amount | 51979.3 |
| Total Medicare Allowed Amount | 27495.57 |
| Total Medicare Payment Amount | 21013.64 |
| Total Medicare Standardized Payment Amount | 24194.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 39 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 1864.3 |
| Total Drug Medicare AllowedAmount | 1463.31 |
| Total Drug Medicare PaymentAmount | 1420.94 |
| Total Drug Medicare Standardized Payment Amount | 1420.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 483 |
| Number Of Medicare Beneficiaries With Medical Services | 164 |
| Total Medical Submitted Charge Amount | 50115 |
| Total Medical Medicare Allowed Amount | 26032.26 |
| Total Medical Medicare Payment Amount | 19592.7 |
| Total Medical Medicare Standardized Payment Amount | 22773.34 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 93 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 131 |
| Number Of Male Beneficiaries | 33 |
| 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 | 135 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 29 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7985 |