| National Provider Identifier [NPI]: | 1710227905 |
| Last Name Of The Provider | TILLERY |
| First Name Of The Provider | CASEY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | ANP, GNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1600 22ND AVE |
| Street Address 2 Of The Provider | MEDICAL TOWERS III |
| City Of The Provider | MERIDIAN |
| Zip Code Of The Provider | 393013223 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 795 |
| Number Of Medicare Beneficiaries | 76 |
| Total Submitted Charge Amount | 47102.1 |
| Total Medicare Allowed Amount | 17800.54 |
| Total Medicare Payment Amount | 13428.4 |
| Total Medicare Standardized Payment Amount | 16655.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 252 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 1574.1 |
| Total Drug Medicare AllowedAmount | 332.33 |
| Total Drug Medicare PaymentAmount | 278.09 |
| Total Drug Medicare Standardized Payment Amount | 278.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 543 |
| Number Of Medicare Beneficiaries With Medical Services | 76 |
| Total Medical Submitted Charge Amount | 45528 |
| Total Medical Medicare Allowed Amount | 17468.21 |
| Total Medical Medicare Payment Amount | 13150.31 |
| Total Medical Medicare Standardized Payment Amount | 16377.34 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 25 |
| Number Of Beneficiaries Age 75 to 84 | 31 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 54 |
| Number Of Male Beneficiaries | 22 |
| 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 | 62 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 37 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 51 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 20 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4393 |