| National Provider Identifier [NPI]: | 1033480116 |
| Last Name Of The Provider | TANNER |
| First Name Of The Provider | KIMBERLY |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | APN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7 SHACKLEFORD WEST BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LITTLE ROCK |
| Zip Code Of The Provider | 722113714 |
| 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 | 51 |
| Number Of Services | 1531 |
| Number Of Medicare Beneficiaries | 455 |
| Total Submitted Charge Amount | 138726.25 |
| Total Medicare Allowed Amount | 46512.56 |
| Total Medicare Payment Amount | 30177.33 |
| Total Medicare Standardized Payment Amount | 40046.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 17 |
| Number Of Drug Services | 520 |
| Number Of Medicare Beneficiaries With Drug Services | 73 |
| Total Drug Submitted ChargeAmount | 3785 |
| Total Drug Medicare AllowedAmount | 556.18 |
| Total Drug Medicare PaymentAmount | 403.29 |
| Total Drug Medicare Standardized Payment Amount | 403.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 1011 |
| Number Of Medicare Beneficiaries With Medical Services | 455 |
| Total Medical Submitted Charge Amount | 134941.25 |
| Total Medical Medicare Allowed Amount | 45956.38 |
| Total Medical Medicare Payment Amount | 29774.04 |
| Total Medical Medicare Standardized Payment Amount | 39642.86 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 98 |
| Number Of Beneficiaries Age 65 to 74 | 174 |
| Number Of Beneficiaries Age 75 to 84 | 137 |
| Number Of Beneficiaries Age Greater 84 | 46 |
| Number Of Female Beneficiaries | 237 |
| Number Of Male Beneficiaries | 218 |
| Number Of Non Hispanic White Beneficiaries | 385 |
| 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 | 358 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 97 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3952 |