| National Provider Identifier [NPI]: | 1003902578 |
| Last Name Of The Provider | HENSLEY |
| First Name Of The Provider | SALLY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | APRN, FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 153 E BROADWAY BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | JEFFERSON CITY |
| Zip Code Of The Provider | 377602517 |
| 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 | 14 |
| Number Of Services | 156 |
| Number Of Medicare Beneficiaries | 94 |
| Total Submitted Charge Amount | 7932 |
| Total Medicare Allowed Amount | 7480.44 |
| Total Medicare Payment Amount | 4198.02 |
| Total Medicare Standardized Payment Amount | 6437.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 92.74 |
| Total Drug Medicare AllowedAmount | 30.77 |
| Total Drug Medicare PaymentAmount | 27.76 |
| Total Drug Medicare Standardized Payment Amount | 27.76 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 120 |
| Number Of Medicare Beneficiaries With Medical Services | 94 |
| Total Medical Submitted Charge Amount | 7839.26 |
| Total Medical Medicare Allowed Amount | 7449.67 |
| Total Medical Medicare Payment Amount | 4170.26 |
| Total Medical Medicare Standardized Payment Amount | 6409.92 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 59 |
| Number Of Beneficiaries Age 75 to 84 | 18 |
| Number Of Beneficiaries Age Greater 84 | 0 |
| Number Of Female Beneficiaries | 60 |
| Number Of Male Beneficiaries | 34 |
| 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 | 73 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 12 |
| 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 | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 22 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7992 |