| National Provider Identifier [NPI]: | 1144658063 |
| Last Name Of The Provider | DORN |
| First Name Of The Provider | NICHOLE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2602 J ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681071643 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 114 |
| Number Of Medicare Beneficiaries | 54 |
| Total Submitted Charge Amount | 10999.53 |
| Total Medicare Allowed Amount | 3710.94 |
| Total Medicare Payment Amount | 2568.06 |
| Total Medicare Standardized Payment Amount | 3433.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 16 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 608 |
| Total Drug Medicare AllowedAmount | 533.92 |
| Total Drug Medicare PaymentAmount | 523.2 |
| Total Drug Medicare Standardized Payment Amount | 523.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 98 |
| Number Of Medicare Beneficiaries With Medical Services | 54 |
| Total Medical Submitted Charge Amount | 10391.53 |
| Total Medical Medicare Allowed Amount | 3177.02 |
| Total Medical Medicare Payment Amount | 2044.86 |
| Total Medical Medicare Standardized Payment Amount | 2910.7 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 32 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 36 |
| Number Of Male Beneficiaries | 18 |
| Number Of Non Hispanic White Beneficiaries | 28 |
| 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 | 42 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 0 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.9185 |