| National Provider Identifier [NPI]: | 1477689883 |
| Last Name Of The Provider | SHEEN |
| First Name Of The Provider | TABITHA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | APNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2000 E. LAYTON AVE. |
| Street Address 2 Of The Provider | LAKESHORE MEDICAL CLINIC |
| City Of The Provider | ST. FRANCIS |
| Zip Code Of The Provider | 532356053 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 767 |
| Number Of Medicare Beneficiaries | 308 |
| Total Submitted Charge Amount | 123272.45 |
| Total Medicare Allowed Amount | 36129.96 |
| Total Medicare Payment Amount | 24435.8 |
| Total Medicare Standardized Payment Amount | 31273.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 227 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 2516.45 |
| Total Drug Medicare AllowedAmount | 1314.53 |
| Total Drug Medicare PaymentAmount | 1254.78 |
| Total Drug Medicare Standardized Payment Amount | 1254.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 540 |
| Number Of Medicare Beneficiaries With Medical Services | 308 |
| Total Medical Submitted Charge Amount | 120756 |
| Total Medical Medicare Allowed Amount | 34815.43 |
| Total Medical Medicare Payment Amount | 23181.02 |
| Total Medical Medicare Standardized Payment Amount | 30018.96 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 66 |
| Number Of Beneficiaries Age 65 to 74 | 120 |
| Number Of Beneficiaries Age 75 to 84 | 74 |
| Number Of Beneficiaries Age Greater 84 | 48 |
| Number Of Female Beneficiaries | 196 |
| Number Of Male Beneficiaries | 112 |
| Number Of Non Hispanic White Beneficiaries | 258 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 228 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 80 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.275 |