| National Provider Identifier [NPI]: | 1750468294 |
| Last Name Of The Provider | LOGAN |
| First Name Of The Provider | IRENE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | NURSE PRACTITIONER |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 516 MONTAUK HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | EAST MORICHES |
| Zip Code Of The Provider | 119401225 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 1336 |
| Number Of Medicare Beneficiaries | 200 |
| Total Submitted Charge Amount | 116966.5 |
| Total Medicare Allowed Amount | 72931.85 |
| Total Medicare Payment Amount | 56219.26 |
| Total Medicare Standardized Payment Amount | 59052.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 73 |
| Number Of Medicare Beneficiaries With Drug Services | 53 |
| Total Drug Submitted ChargeAmount | 2524.5 |
| Total Drug Medicare AllowedAmount | 1274.45 |
| Total Drug Medicare PaymentAmount | 1230.26 |
| Total Drug Medicare Standardized Payment Amount | 1230.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 1263 |
| Number Of Medicare Beneficiaries With Medical Services | 200 |
| Total Medical Submitted Charge Amount | 114442 |
| Total Medical Medicare Allowed Amount | 71657.4 |
| Total Medical Medicare Payment Amount | 54989 |
| Total Medical Medicare Standardized Payment Amount | 57822.39 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 46 |
| Number Of Beneficiaries Age 75 to 84 | 45 |
| Number Of Beneficiaries Age Greater 84 | 69 |
| Number Of Female Beneficiaries | 118 |
| Number Of Male Beneficiaries | 82 |
| Number Of Non Hispanic White Beneficiaries | 185 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| 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 | 106 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 94 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 55 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 35 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 1.9827 |