| National Provider Identifier [NPI]: | 1245343896 |
| Last Name Of The Provider | COUSINS |
| First Name Of The Provider | DIANE |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1610 10TH ST |
| Street Address 2 Of The Provider | CLARK-HOLDER CLINIC, P.A. |
| City Of The Provider | WEST POINT |
| Zip Code Of The Provider | 31833 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 2824 |
| Number Of Medicare Beneficiaries | 343 |
| Total Submitted Charge Amount | 336140 |
| Total Medicare Allowed Amount | 90205.4 |
| Total Medicare Payment Amount | 58329.74 |
| Total Medicare Standardized Payment Amount | 73510.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 787 |
| Number Of Medicare Beneficiaries With Drug Services | 135 |
| Total Drug Submitted ChargeAmount | 20833 |
| Total Drug Medicare AllowedAmount | 4405.23 |
| Total Drug Medicare PaymentAmount | 3923.11 |
| Total Drug Medicare Standardized Payment Amount | 3923.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 2037 |
| Number Of Medicare Beneficiaries With Medical Services | 343 |
| Total Medical Submitted Charge Amount | 315307 |
| Total Medical Medicare Allowed Amount | 85800.17 |
| Total Medical Medicare Payment Amount | 54406.63 |
| Total Medical Medicare Standardized Payment Amount | 69587.19 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 87 |
| Number Of Beneficiaries Age 65 to 74 | 139 |
| Number Of Beneficiaries Age 75 to 84 | 84 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 221 |
| Number Of Male Beneficiaries | 122 |
| Number Of Non Hispanic White Beneficiaries | 237 |
| 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 | 243 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 100 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9904 |