| National Provider Identifier [NPI]: | 1780883447 |
| Last Name Of The Provider | KIDANE |
| First Name Of The Provider | MEKONNEN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | NP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 111 HW 70 EAST |
| Street Address 2 Of The Provider | |
| City Of The Provider | DICKSON |
| Zip Code Of The Provider | 37055 |
| 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 | 8 |
| Number Of Services | 1062 |
| Number Of Medicare Beneficiaries | 335 |
| Total Submitted Charge Amount | 75986 |
| Total Medicare Allowed Amount | 55237.97 |
| Total Medicare Payment Amount | 41905.24 |
| Total Medicare Standardized Payment Amount | 53622.65 |
| 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 | 8 |
| Number Of Medical Services | 1062 |
| Number Of Medicare Beneficiaries With Medical Services | 335 |
| Total Medical Submitted Charge Amount | 75986 |
| Total Medical Medicare Allowed Amount | 55237.97 |
| Total Medical Medicare Payment Amount | 41905.24 |
| Total Medical Medicare Standardized Payment Amount | 53622.65 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 77 |
| Number Of Beneficiaries Age 75 to 84 | 107 |
| Number Of Beneficiaries Age Greater 84 | 114 |
| Number Of Female Beneficiaries | 229 |
| Number Of Male Beneficiaries | 106 |
| Number Of Non Hispanic White Beneficiaries | 317 |
| 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 | 148 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 187 |
| Percent Of With Atrial Fibrillation | 31 |
| Percent Of With Alzheimers Disease or Dementia | 55 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 59 |
| Percent Of With Chronic Kidney Disease | 55 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 52 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 27 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.4911 |