| National Provider Identifier [NPI]: | 1568700979 |
| Last Name Of The Provider | ADETIBA |
| First Name Of The Provider | BOLAJI |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MSN-ANP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9 MEDICAL PKWY |
| Street Address 2 Of The Provider | STE 308 |
| City Of The Provider | DALLAS |
| Zip Code Of The Provider | 752347858 |
| 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 | 17 |
| Number Of Services | 1421 |
| Number Of Medicare Beneficiaries | 280 |
| Total Submitted Charge Amount | 363829.62 |
| Total Medicare Allowed Amount | 175714.19 |
| Total Medicare Payment Amount | 131490.4 |
| Total Medicare Standardized Payment Amount | 154271.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 68 |
| Number Of Medicare Beneficiaries With Drug Services | 68 |
| Total Drug Submitted ChargeAmount | 1837.98 |
| Total Drug Medicare AllowedAmount | 1769.96 |
| Total Drug Medicare PaymentAmount | 1734.57 |
| Total Drug Medicare Standardized Payment Amount | 1734.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 1353 |
| Number Of Medicare Beneficiaries With Medical Services | 280 |
| Total Medical Submitted Charge Amount | 361991.64 |
| Total Medical Medicare Allowed Amount | 173944.23 |
| Total Medical Medicare Payment Amount | 129755.83 |
| Total Medical Medicare Standardized Payment Amount | 152536.67 |
| Average Age Of Beneficiaries | 83 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 35 |
| Number Of Beneficiaries Age 75 to 84 | 96 |
| Number Of Beneficiaries Age Greater 84 | 136 |
| Number Of Female Beneficiaries | 207 |
| Number Of Male Beneficiaries | 73 |
| Number Of Non Hispanic White Beneficiaries | 182 |
| Number Of Black or African American Beneficiaries | 71 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 27 |
| 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 | 189 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 91 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 67 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 48 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 57 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 26 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 69 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.2005 |