| National Provider Identifier [NPI]: | 1477987923 |
| Last Name Of The Provider | GUILLEMETTE |
| First Name Of The Provider | IRIS |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MSN, APRN, PMHNP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 540 LITCHFIELD ST |
| Street Address 2 Of The Provider | MEMORIAL BUILDING, 2ND FLOOR |
| City Of The Provider | TORRINGTON |
| Zip Code Of The Provider | 067906679 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 4 |
| Number Of Services | 707 |
| Number Of Medicare Beneficiaries | 177 |
| Total Submitted Charge Amount | 187899.25 |
| Total Medicare Allowed Amount | 40100.07 |
| Total Medicare Payment Amount | 31051.43 |
| Total Medicare Standardized Payment Amount | 34594.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 4 |
| Number Of Medical Services | 707 |
| Number Of Medicare Beneficiaries With Medical Services | 177 |
| Total Medical Submitted Charge Amount | 187899.25 |
| Total Medical Medicare Allowed Amount | 40100.07 |
| Total Medical Medicare Payment Amount | 31051.43 |
| Total Medical Medicare Standardized Payment Amount | 34594.95 |
| Average Age Of Beneficiaries | 54 |
| Number Of Beneficiaries Age Less65 | 139 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 108 |
| Number Of Male Beneficiaries | 69 |
| Number Of Non Hispanic White Beneficiaries | 162 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 20 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 157 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 11 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 34 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3188 |