| National Provider Identifier [NPI]: | 1184677437 |
| Last Name Of The Provider | DOUGLASS |
| First Name Of The Provider | MERILYN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 311 E SPRUCE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | GARDEN CITY |
| Zip Code Of The Provider | 678465614 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 1813 |
| Number Of Medicare Beneficiaries | 89 |
| Total Submitted Charge Amount | 95503.1 |
| Total Medicare Allowed Amount | 32672.28 |
| Total Medicare Payment Amount | 25571.56 |
| Total Medicare Standardized Payment Amount | 28039.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 29 |
| Number Of Drug Services | 1572 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 57794.2 |
| Total Drug Medicare AllowedAmount | 18425.91 |
| Total Drug Medicare PaymentAmount | 14446 |
| Total Drug Medicare Standardized Payment Amount | 14446 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 241 |
| Number Of Medicare Beneficiaries With Medical Services | 88 |
| Total Medical Submitted Charge Amount | 37708.9 |
| Total Medical Medicare Allowed Amount | 14246.37 |
| Total Medical Medicare Payment Amount | 11125.56 |
| Total Medical Medicare Standardized Payment Amount | 13593.42 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 42 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 43 |
| Number Of Male Beneficiaries | 46 |
| Number Of Non Hispanic White Beneficiaries | 76 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 71 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 56 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.7122 |