| National Provider Identifier [NPI]: | 1053647461 |
| Last Name Of The Provider | MODEBELU |
| First Name Of The Provider | PHILLIPA |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | RN/NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 801 N TARRANT PKWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | KELLER |
| Zip Code Of The Provider | 762486860 |
| 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 | 16 |
| Number Of Services | 211 |
| Number Of Medicare Beneficiaries | 109 |
| Total Submitted Charge Amount | 9952.42 |
| Total Medicare Allowed Amount | 8923.35 |
| Total Medicare Payment Amount | 7072.65 |
| Total Medicare Standardized Payment Amount | 8157.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 64 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 2043.42 |
| Total Drug Medicare AllowedAmount | 2043.42 |
| Total Drug Medicare PaymentAmount | 2000.56 |
| Total Drug Medicare Standardized Payment Amount | 2000.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 147 |
| Number Of Medicare Beneficiaries With Medical Services | 109 |
| Total Medical Submitted Charge Amount | 7909 |
| Total Medical Medicare Allowed Amount | 6879.93 |
| Total Medical Medicare Payment Amount | 5072.09 |
| Total Medical Medicare Standardized Payment Amount | 6157.35 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 81 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 70 |
| Number Of Male Beneficiaries | 39 |
| Number Of Non Hispanic White Beneficiaries | 96 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6299 |