| National Provider Identifier [NPI]: | 1396783908 |
| Last Name Of The Provider | MELLOR |
| First Name Of The Provider | SANDRA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | APPN, FNP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5780 S PEORIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741057857 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 1340 |
| Number Of Medicare Beneficiaries | 108 |
| Total Submitted Charge Amount | 71357.5 |
| Total Medicare Allowed Amount | 43621.05 |
| Total Medicare Payment Amount | 33117.43 |
| Total Medicare Standardized Payment Amount | 42484.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 196 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 3185 |
| Total Drug Medicare AllowedAmount | 267.5 |
| Total Drug Medicare PaymentAmount | 231.96 |
| Total Drug Medicare Standardized Payment Amount | 231.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 1144 |
| Number Of Medicare Beneficiaries With Medical Services | 108 |
| Total Medical Submitted Charge Amount | 68172.5 |
| Total Medical Medicare Allowed Amount | 43353.55 |
| Total Medical Medicare Payment Amount | 32885.47 |
| Total Medical Medicare Standardized Payment Amount | 42252.98 |
| Average Age Of Beneficiaries | 50 |
| Number Of Beneficiaries Age Less65 | 90 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 64 |
| Number Of Male Beneficiaries | 44 |
| Number Of Non Hispanic White Beneficiaries | 64 |
| 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 | 14 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 94 |
| Percent Of With Atrial Fibrillation | 0 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 48 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.137 |