| National Provider Identifier [NPI]: | 1649509332 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | ALICIA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | RN, MSN, FNP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 E TICKLE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | DYERSBURG |
| Zip Code Of The Provider | 380243120 |
| 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 | 58 |
| Number Of Services | 804 |
| Number Of Medicare Beneficiaries | 188 |
| Total Submitted Charge Amount | 35163.38 |
| Total Medicare Allowed Amount | 22834.88 |
| Total Medicare Payment Amount | 14755.64 |
| Total Medicare Standardized Payment Amount | 19774.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 331 |
| Number Of Medicare Beneficiaries With Drug Services | 56 |
| Total Drug Submitted ChargeAmount | 3892 |
| Total Drug Medicare AllowedAmount | 408.03 |
| Total Drug Medicare PaymentAmount | 310.43 |
| Total Drug Medicare Standardized Payment Amount | 310.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 473 |
| Number Of Medicare Beneficiaries With Medical Services | 187 |
| Total Medical Submitted Charge Amount | 31271.38 |
| Total Medical Medicare Allowed Amount | 22426.85 |
| Total Medical Medicare Payment Amount | 14445.21 |
| Total Medical Medicare Standardized Payment Amount | 19464.56 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 61 |
| Number Of Beneficiaries Age 65 to 74 | 86 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 118 |
| Number Of Male Beneficiaries | 70 |
| Number Of Non Hispanic White Beneficiaries | 166 |
| 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 | 131 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9458 |