| National Provider Identifier [NPI]: | 1366706921 |
| Last Name Of The Provider | HUNTSMAN |
| First Name Of The Provider | MARISSA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9009 MOUNTAIN RIDGE DR |
| Street Address 2 Of The Provider | STE A140 |
| City Of The Provider | AUSTIN |
| Zip Code Of The Provider | 787597286 |
| 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 | 14 |
| Number Of Services | 719 |
| Number Of Medicare Beneficiaries | 162 |
| Total Submitted Charge Amount | 109280.42 |
| Total Medicare Allowed Amount | 55791.84 |
| Total Medicare Payment Amount | 43466.24 |
| Total Medicare Standardized Payment Amount | 51289.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 719 |
| Number Of Medicare Beneficiaries With Medical Services | 162 |
| Total Medical Submitted Charge Amount | 109280.42 |
| Total Medical Medicare Allowed Amount | 55791.84 |
| Total Medical Medicare Payment Amount | 43466.24 |
| Total Medical Medicare Standardized Payment Amount | 51289.72 |
| Average Age Of Beneficiaries | 81 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 24 |
| Number Of Beneficiaries Age 75 to 84 | 47 |
| Number Of Beneficiaries Age Greater 84 | 76 |
| Number Of Female Beneficiaries | 97 |
| Number Of Male Beneficiaries | 65 |
| Number Of Non Hispanic White Beneficiaries | 139 |
| 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 | 125 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 66 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 57 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.3812 |