| National Provider Identifier [NPI]: | 1679728026 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | KATHLEEN |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | DSN, CPNP, FNP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2406 E PLAZA DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | TALLAHASSEE |
| Zip Code Of The Provider | 323085301 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 1801 |
| Number Of Medicare Beneficiaries | 249 |
| Total Submitted Charge Amount | 135002 |
| Total Medicare Allowed Amount | 49133.92 |
| Total Medicare Payment Amount | 36137.65 |
| Total Medicare Standardized Payment Amount | 40733.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 867 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 35025 |
| Total Drug Medicare AllowedAmount | 11449.9 |
| Total Drug Medicare PaymentAmount | 8774.68 |
| Total Drug Medicare Standardized Payment Amount | 8774.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 934 |
| Number Of Medicare Beneficiaries With Medical Services | 249 |
| Total Medical Submitted Charge Amount | 99977 |
| Total Medical Medicare Allowed Amount | 37684.02 |
| Total Medical Medicare Payment Amount | 27362.97 |
| Total Medical Medicare Standardized Payment Amount | 31959.04 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 97 |
| Number Of Beneficiaries Age 75 to 84 | 66 |
| Number Of Beneficiaries Age Greater 84 | 40 |
| Number Of Female Beneficiaries | 160 |
| Number Of Male Beneficiaries | 89 |
| Number Of Non Hispanic White Beneficiaries | 202 |
| 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 | 198 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1261 |