| National Provider Identifier [NPI]: | 1609066950 |
| Last Name Of The Provider | COOK |
| First Name Of The Provider | JACQUELINE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | BC-FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 960 E WALNUT LAWN |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 65807 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 1009 |
| Number Of Medicare Beneficiaries | 387 |
| Total Submitted Charge Amount | 91064 |
| Total Medicare Allowed Amount | 44237.91 |
| Total Medicare Payment Amount | 31522.68 |
| Total Medicare Standardized Payment Amount | 40229.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 79 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 5535 |
| Total Drug Medicare AllowedAmount | 1938.7 |
| Total Drug Medicare PaymentAmount | 1548.85 |
| Total Drug Medicare Standardized Payment Amount | 1548.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 930 |
| Number Of Medicare Beneficiaries With Medical Services | 387 |
| Total Medical Submitted Charge Amount | 85529 |
| Total Medical Medicare Allowed Amount | 42299.21 |
| Total Medical Medicare Payment Amount | 29973.83 |
| Total Medical Medicare Standardized Payment Amount | 38680.52 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 123 |
| Number Of Beneficiaries Age 65 to 74 | 166 |
| Number Of Beneficiaries Age 75 to 84 | 74 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 256 |
| Number Of Male Beneficiaries | 131 |
| Number Of Non Hispanic White Beneficiaries | 375 |
| 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 | 293 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 94 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 75 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.5067 |