| National Provider Identifier [NPI]: | 1912114711 |
| Last Name Of The Provider | LAVIGNE |
| First Name Of The Provider | THADDEUS |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | N.P. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10059 N REIGER RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BATON ROUGE |
| Zip Code Of The Provider | 708094559 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 239 |
| Number Of Medicare Beneficiaries | 92 |
| Total Submitted Charge Amount | 16301.39 |
| Total Medicare Allowed Amount | 7529.06 |
| Total Medicare Payment Amount | 4610.76 |
| Total Medicare Standardized Payment Amount | 6228.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 76 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 679 |
| Total Drug Medicare AllowedAmount | 400.33 |
| Total Drug Medicare PaymentAmount | 221.45 |
| Total Drug Medicare Standardized Payment Amount | 221.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 163 |
| Number Of Medicare Beneficiaries With Medical Services | 92 |
| Total Medical Submitted Charge Amount | 15622.39 |
| Total Medical Medicare Allowed Amount | 7128.73 |
| Total Medical Medicare Payment Amount | 4389.31 |
| Total Medical Medicare Standardized Payment Amount | 6006.59 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 46 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 53 |
| Number Of Male Beneficiaries | 39 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 68 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| 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 | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9274 |