| National Provider Identifier [NPI]: | 1659453546 |
| Last Name Of The Provider | MALL |
| First Name Of The Provider | KRISTINE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | RN BC ANP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 791 NE ANDERSON LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | LEES SUMMIT |
| Zip Code Of The Provider | 64064 |
| 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 | 95 |
| Number Of Services | 1656 |
| Number Of Medicare Beneficiaries | 643 |
| Total Submitted Charge Amount | 136695 |
| Total Medicare Allowed Amount | 79660.94 |
| Total Medicare Payment Amount | 60229.35 |
| Total Medicare Standardized Payment Amount | 72977.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 57 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 1871 |
| Total Drug Medicare AllowedAmount | 986.45 |
| Total Drug Medicare PaymentAmount | 943.02 |
| Total Drug Medicare Standardized Payment Amount | 943.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 86 |
| Number Of Medical Services | 1599 |
| Number Of Medicare Beneficiaries With Medical Services | 643 |
| Total Medical Submitted Charge Amount | 134824 |
| Total Medical Medicare Allowed Amount | 78674.49 |
| Total Medical Medicare Payment Amount | 59286.33 |
| Total Medical Medicare Standardized Payment Amount | 72034.29 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 82 |
| Number Of Beneficiaries Age 65 to 74 | 227 |
| Number Of Beneficiaries Age 75 to 84 | 224 |
| Number Of Beneficiaries Age Greater 84 | 110 |
| Number Of Female Beneficiaries | 410 |
| Number Of Male Beneficiaries | 233 |
| Number Of Non Hispanic White Beneficiaries | 546 |
| Number Of Black or African American Beneficiaries | 75 |
| 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 | 589 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.092 |