| National Provider Identifier [NPI]: | 1598953572 |
| Last Name Of The Provider | HICKSON |
| First Name Of The Provider | MARILYN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 518 KINNEY DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | BELTON |
| Zip Code Of The Provider | 765131411 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 1695 |
| Number Of Medicare Beneficiaries | 189 |
| Total Submitted Charge Amount | 40891.96 |
| Total Medicare Allowed Amount | 32020.24 |
| Total Medicare Payment Amount | 18095.52 |
| Total Medicare Standardized Payment Amount | 24288.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 1098 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 80.91 |
| Total Drug Medicare AllowedAmount | 80.91 |
| Total Drug Medicare PaymentAmount | 63.49 |
| Total Drug Medicare Standardized Payment Amount | 63.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 6 |
| Number Of Medical Services | 597 |
| Number Of Medicare Beneficiaries With Medical Services | 189 |
| Total Medical Submitted Charge Amount | 40811.05 |
| Total Medical Medicare Allowed Amount | 31939.33 |
| Total Medical Medicare Payment Amount | 18032.03 |
| Total Medical Medicare Standardized Payment Amount | 24225.06 |
| Average Age Of Beneficiaries | 49 |
| Number Of Beneficiaries Age Less65 | 172 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 105 |
| Number Of Male Beneficiaries | 84 |
| Number Of Non Hispanic White Beneficiaries | 110 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 49 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 140 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 53 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 24 |
| Percent Of With Hypertension | 45 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 19 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 57 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.2419 |