| National Provider Identifier [NPI]: | 1104054147 |
| Last Name Of The Provider | PORCH-PETITT |
| First Name Of The Provider | LISHA |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | CNS |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2000 S WHEELING AVE |
| Street Address 2 Of The Provider | STE 200 |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741045649 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Certified Clinical Nurse Specialist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 7 |
| Number Of Services | 319 |
| Number Of Medicare Beneficiaries | 85 |
| Total Submitted Charge Amount | 22059 |
| Total Medicare Allowed Amount | 9699.59 |
| Total Medicare Payment Amount | 6293.35 |
| Total Medicare Standardized Payment Amount | 7690.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 197 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 2742 |
| Total Drug Medicare AllowedAmount | 1125.92 |
| Total Drug Medicare PaymentAmount | 857.43 |
| Total Drug Medicare Standardized Payment Amount | 857.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 5 |
| Number Of Medical Services | 122 |
| Number Of Medicare Beneficiaries With Medical Services | 85 |
| Total Medical Submitted Charge Amount | 19317 |
| Total Medical Medicare Allowed Amount | 8573.67 |
| Total Medical Medicare Payment Amount | 5435.92 |
| Total Medical Medicare Standardized Payment Amount | 6833.09 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 29 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 56 |
| Number Of Male Beneficiaries | 29 |
| Number Of Non Hispanic White Beneficiaries | 68 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 67 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3221 |