| National Provider Identifier [NPI]: | 1710255997 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | SETH |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 289 WOODLAND DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | WINDER |
| Zip Code Of The Provider | 306802426 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 293 |
| Number Of Medicare Beneficiaries | 154 |
| Total Submitted Charge Amount | 13221.13 |
| Total Medicare Allowed Amount | 11945.2 |
| Total Medicare Payment Amount | 8837.04 |
| Total Medicare Standardized Payment Amount | 10112.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 87 |
| Number Of Medicare Beneficiaries With Drug Services | 81 |
| Total Drug Submitted ChargeAmount | 2711.13 |
| Total Drug Medicare AllowedAmount | 2711.13 |
| Total Drug Medicare PaymentAmount | 2646.12 |
| Total Drug Medicare Standardized Payment Amount | 2646.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 206 |
| Number Of Medicare Beneficiaries With Medical Services | 154 |
| Total Medical Submitted Charge Amount | 10510 |
| Total Medical Medicare Allowed Amount | 9234.07 |
| Total Medical Medicare Payment Amount | 6190.92 |
| Total Medical Medicare Standardized Payment Amount | 7466.09 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 103 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 97 |
| Number Of Male Beneficiaries | 57 |
| Number Of Non Hispanic White Beneficiaries | 139 |
| 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 | |
| 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 | |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6443 |