| National Provider Identifier [NPI]: | 1619199072 |
| Last Name Of The Provider | NIETERT |
| First Name Of The Provider | ELIZABETH |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 751 N RUTLEDGE ST |
| Street Address 2 Of The Provider | SUITE 2300 |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627024968 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 4117 |
| Number Of Medicare Beneficiaries | 823 |
| Total Submitted Charge Amount | 743331.98 |
| Total Medicare Allowed Amount | 226825.46 |
| Total Medicare Payment Amount | 161808.09 |
| Total Medicare Standardized Payment Amount | 167984.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 143 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 2107.02 |
| Total Drug Medicare AllowedAmount | 253.13 |
| Total Drug Medicare PaymentAmount | 198.39 |
| Total Drug Medicare Standardized Payment Amount | 198.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 3974 |
| Number Of Medicare Beneficiaries With Medical Services | 822 |
| Total Medical Submitted Charge Amount | 741224.96 |
| Total Medical Medicare Allowed Amount | 226572.33 |
| Total Medical Medicare Payment Amount | 161609.7 |
| Total Medical Medicare Standardized Payment Amount | 167785.99 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 74 |
| Number Of Beneficiaries Age 65 to 74 | 387 |
| Number Of Beneficiaries Age 75 to 84 | 250 |
| Number Of Beneficiaries Age Greater 84 | 112 |
| Number Of Female Beneficiaries | 407 |
| Number Of Male Beneficiaries | 416 |
| Number Of Non Hispanic White Beneficiaries | 795 |
| 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 | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 721 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 102 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0367 |