| National Provider Identifier [NPI]: | 1275510836 |
| Last Name Of The Provider | LEIBECKE |
| First Name Of The Provider | ANA |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1989 MIAMISBURG CENTERVILLE RD |
| Street Address 2 Of The Provider | SUITE NUMBER 204 |
| City Of The Provider | DAYTON |
| Zip Code Of The Provider | 454593859 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 7 |
| Number Of Services | 30 |
| Number Of Medicare Beneficiaries | 16 |
| Total Submitted Charge Amount | 1097.89 |
| Total Medicare Allowed Amount | 958.63 |
| Total Medicare Payment Amount | 857.69 |
| Total Medicare Standardized Payment Amount | 955.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 11 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 320.89 |
| Total Drug Medicare AllowedAmount | 320.89 |
| Total Drug Medicare PaymentAmount | 303.7 |
| Total Drug Medicare Standardized Payment Amount | 303.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 5 |
| Number Of Medical Services | 19 |
| Number Of Medicare Beneficiaries With Medical Services | 15 |
| Total Medical Submitted Charge Amount | 777 |
| Total Medical Medicare Allowed Amount | 637.74 |
| Total Medical Medicare Payment Amount | 553.99 |
| Total Medical Medicare Standardized Payment Amount | 651.67 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| 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 | 0 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 0 |
| 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 | |
| Percent Of With Hyperlipidemia | |
| Percent Of With Hypertension | |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.0132 |