| National Provider Identifier [NPI]: | 1649550708 |
| Last Name Of The Provider | PICKLE |
| First Name Of The Provider | TERESA |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | N.P. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14430 MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | COFFEEVILLE |
| Zip Code Of The Provider | 389222590 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 131 |
| Number Of Medicare Beneficiaries | 33 |
| Total Submitted Charge Amount | 7283 |
| Total Medicare Allowed Amount | 3663.34 |
| Total Medicare Payment Amount | 2927.73 |
| Total Medicare Standardized Payment Amount | 3465.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 25 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 563 |
| Total Drug Medicare AllowedAmount | 131.67 |
| Total Drug Medicare PaymentAmount | 103.08 |
| Total Drug Medicare Standardized Payment Amount | 103.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 106 |
| Number Of Medicare Beneficiaries With Medical Services | 33 |
| Total Medical Submitted Charge Amount | 6720 |
| Total Medical Medicare Allowed Amount | 3531.67 |
| Total Medical Medicare Payment Amount | 2824.65 |
| Total Medical Medicare Standardized Payment Amount | 3362.64 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 14 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 19 |
| Number Of Male Beneficiaries | 14 |
| Number Of Non Hispanic White Beneficiaries | 22 |
| Number Of Black or African American Beneficiaries | 11 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| 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 | |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.0368 |