| National Provider Identifier [NPI]: | 1235380064 |
| Last Name Of The Provider | DETMER |
| First Name Of The Provider | STACIE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5034 GRIFFIN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631283418 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 82 |
| Number Of Services | 1149 |
| Number Of Medicare Beneficiaries | 269 |
| Total Submitted Charge Amount | 84670 |
| Total Medicare Allowed Amount | 41205.58 |
| Total Medicare Payment Amount | 28886.7 |
| Total Medicare Standardized Payment Amount | 34525.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 1569 |
| Total Drug Medicare AllowedAmount | 773.43 |
| Total Drug Medicare PaymentAmount | 721.22 |
| Total Drug Medicare Standardized Payment Amount | 721.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 74 |
| Number Of Medical Services | 1115 |
| Number Of Medicare Beneficiaries With Medical Services | 269 |
| Total Medical Submitted Charge Amount | 83101 |
| Total Medical Medicare Allowed Amount | 40432.15 |
| Total Medical Medicare Payment Amount | 28165.48 |
| Total Medical Medicare Standardized Payment Amount | 33803.8 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 122 |
| Number Of Beneficiaries Age 75 to 84 | 86 |
| Number Of Beneficiaries Age Greater 84 | 43 |
| Number Of Female Beneficiaries | 156 |
| Number Of Male Beneficiaries | 113 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9232 |