| National Provider Identifier [NPI]: | 1457793382 |
| Last Name Of The Provider | MOORE |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | APRN, FNP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2707 JACKSBORO PIKE |
| Street Address 2 Of The Provider | SUITE 1A |
| City Of The Provider | JACKSBORO |
| Zip Code Of The Provider | 377572752 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 393 |
| Number Of Medicare Beneficiaries | 42 |
| Total Submitted Charge Amount | 28083.68 |
| Total Medicare Allowed Amount | 12878.34 |
| Total Medicare Payment Amount | 10203.58 |
| Total Medicare Standardized Payment Amount | 12301.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 87 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 1252 |
| Total Drug Medicare AllowedAmount | 188.27 |
| Total Drug Medicare PaymentAmount | 157.45 |
| Total Drug Medicare Standardized Payment Amount | 157.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 306 |
| Number Of Medicare Beneficiaries With Medical Services | 42 |
| Total Medical Submitted Charge Amount | 26831.68 |
| Total Medical Medicare Allowed Amount | 12690.07 |
| Total Medical Medicare Payment Amount | 10046.13 |
| Total Medical Medicare Standardized Payment Amount | 12143.8 |
| Average Age Of Beneficiaries | 60 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 24 |
| Number Of Male Beneficiaries | 18 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 21 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| 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 | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2987 |