| National Provider Identifier [NPI]: | 1043525173 |
| Last Name Of The Provider | GANNON |
| First Name Of The Provider | TIFFANY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | F.N.P. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 155 HEALTH WAY STE 2 |
| Street Address 2 Of The Provider | |
| City Of The Provider | MCMINNVILLE |
| Zip Code Of The Provider | 371102668 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 688 |
| Number Of Medicare Beneficiaries | 143 |
| Total Submitted Charge Amount | 33337 |
| Total Medicare Allowed Amount | 14627.78 |
| Total Medicare Payment Amount | 11199.54 |
| Total Medicare Standardized Payment Amount | 14160.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 277 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 5728 |
| Total Drug Medicare AllowedAmount | 573.41 |
| Total Drug Medicare PaymentAmount | 495.21 |
| Total Drug Medicare Standardized Payment Amount | 495.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 411 |
| Number Of Medicare Beneficiaries With Medical Services | 143 |
| Total Medical Submitted Charge Amount | 27609 |
| Total Medical Medicare Allowed Amount | 14054.37 |
| Total Medical Medicare Payment Amount | 10704.33 |
| Total Medical Medicare Standardized Payment Amount | 13665.47 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 76 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 87 |
| Number Of Male Beneficiaries | 56 |
| 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 | 123 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0294 |