| National Provider Identifier [NPI]: | 1427451210 |
| Last Name Of The Provider | MCCULLOUGH |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | CFNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 670 LEIGH DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 397053014 |
| 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 | 33 |
| Number Of Services | 201 |
| Number Of Medicare Beneficiaries | 59 |
| Total Submitted Charge Amount | 26475.32 |
| Total Medicare Allowed Amount | 8387.12 |
| Total Medicare Payment Amount | 6475.52 |
| Total Medicare Standardized Payment Amount | 7963.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 41 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 3791.32 |
| Total Drug Medicare AllowedAmount | 1845.91 |
| Total Drug Medicare PaymentAmount | 1442.24 |
| Total Drug Medicare Standardized Payment Amount | 1442.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 160 |
| Number Of Medicare Beneficiaries With Medical Services | 59 |
| Total Medical Submitted Charge Amount | 22684 |
| Total Medical Medicare Allowed Amount | 6541.21 |
| Total Medical Medicare Payment Amount | 5033.28 |
| Total Medical Medicare Standardized Payment Amount | 6521.22 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 27 |
| Number Of Beneficiaries Age 75 to 84 | 15 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 40 |
| Number Of Male Beneficiaries | 19 |
| Number Of Non Hispanic White Beneficiaries | 47 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 47 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| 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 | 20 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 68 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1547 |