| National Provider Identifier [NPI]: | 1699009001 |
| Last Name Of The Provider | CRISP |
| First Name Of The Provider | MARCIE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | RN, FNP-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 301 JENNY GEORGE LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | SWEETWATER |
| Zip Code Of The Provider | 795567152 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 808.4 |
| Number Of Medicare Beneficiaries | 130 |
| Total Submitted Charge Amount | 47801.8 |
| Total Medicare Allowed Amount | 31366.1 |
| Total Medicare Payment Amount | 22293.81 |
| Total Medicare Standardized Payment Amount | 27434.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 278.4 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 4759.8 |
| Total Drug Medicare AllowedAmount | 2073.49 |
| Total Drug Medicare PaymentAmount | 1672.31 |
| Total Drug Medicare Standardized Payment Amount | 1672.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 530 |
| Number Of Medicare Beneficiaries With Medical Services | 129 |
| Total Medical Submitted Charge Amount | 43042 |
| Total Medical Medicare Allowed Amount | 29292.61 |
| Total Medical Medicare Payment Amount | 20621.5 |
| Total Medical Medicare Standardized Payment Amount | 25762.3 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 61 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 91 |
| Number Of Male Beneficiaries | 39 |
| Number Of Non Hispanic White Beneficiaries | 80 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 78 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0042 |