| National Provider Identifier [NPI]: | 1104894658 |
| Last Name Of The Provider | DAUTENHAHN |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10505 E 91ST ST |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741335801 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 680 |
| Number Of Medicare Beneficiaries | 169 |
| Total Submitted Charge Amount | 54696 |
| Total Medicare Allowed Amount | 24166.65 |
| Total Medicare Payment Amount | 15600.27 |
| Total Medicare Standardized Payment Amount | 20802.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 208 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 1438 |
| Total Drug Medicare AllowedAmount | 401.17 |
| Total Drug Medicare PaymentAmount | 346.87 |
| Total Drug Medicare Standardized Payment Amount | 346.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 472 |
| Number Of Medicare Beneficiaries With Medical Services | 169 |
| Total Medical Submitted Charge Amount | 53258 |
| Total Medical Medicare Allowed Amount | 23765.48 |
| Total Medical Medicare Payment Amount | 15253.4 |
| Total Medical Medicare Standardized Payment Amount | 20455.28 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 73 |
| Number Of Beneficiaries Age 75 to 84 | 41 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 123 |
| Number Of Male Beneficiaries | 46 |
| Number Of Non Hispanic White Beneficiaries | 144 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 142 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0716 |