| National Provider Identifier [NPI]: | 1033307996 |
| Last Name Of The Provider | HARRIMAN |
| First Name Of The Provider | AMBER |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | P.A.-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 415 W SOUTH 4TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | RED BUD |
| Zip Code Of The Provider | 622781195 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 278 |
| Number Of Medicare Beneficiaries | 62 |
| Total Submitted Charge Amount | 41421 |
| Total Medicare Allowed Amount | 14928.34 |
| Total Medicare Payment Amount | 10033.82 |
| Total Medicare Standardized Payment Amount | 12781.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 35 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 3366 |
| Total Drug Medicare AllowedAmount | 1069.75 |
| Total Drug Medicare PaymentAmount | 1044.49 |
| Total Drug Medicare Standardized Payment Amount | 1044.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 243 |
| Number Of Medicare Beneficiaries With Medical Services | 62 |
| Total Medical Submitted Charge Amount | 38055 |
| Total Medical Medicare Allowed Amount | 13858.59 |
| Total Medical Medicare Payment Amount | 8989.33 |
| Total Medical Medicare Standardized Payment Amount | 11737.37 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 38 |
| Number Of Beneficiaries Age 75 to 84 | 13 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 41 |
| Number Of Male Beneficiaries | 21 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| 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 | 18 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.8428 |