| National Provider Identifier [NPI]: | 1326024548 |
| Last Name Of The Provider | JACQUES |
| First Name Of The Provider | KRISTA |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | APRN, BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 W JEFFERSON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | KIRKSVILLE |
| Zip Code Of The Provider | 635011443 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 716 |
| Number Of Medicare Beneficiaries | 180 |
| Total Submitted Charge Amount | 76316 |
| Total Medicare Allowed Amount | 32512.62 |
| Total Medicare Payment Amount | 25181.07 |
| Total Medicare Standardized Payment Amount | 29361.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 296 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 13686 |
| Total Drug Medicare AllowedAmount | 11388.82 |
| Total Drug Medicare PaymentAmount | 8929.17 |
| Total Drug Medicare Standardized Payment Amount | 8929.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 420 |
| Number Of Medicare Beneficiaries With Medical Services | 180 |
| Total Medical Submitted Charge Amount | 62630 |
| Total Medical Medicare Allowed Amount | 21123.8 |
| Total Medical Medicare Payment Amount | 16251.9 |
| Total Medical Medicare Standardized Payment Amount | 20432.42 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 73 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 121 |
| Number Of Male Beneficiaries | 59 |
| 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 | 107 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 73 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 70 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.524 |