| National Provider Identifier [NPI]: | 1437195716 |
| Last Name Of The Provider | MCKISSOCK |
| First Name Of The Provider | CAROL |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | APN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 571 CENTRAL AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEW PROVIDENCE |
| Zip Code Of The Provider | 079741547 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 539 |
| Number Of Medicare Beneficiaries | 161 |
| Total Submitted Charge Amount | 90684 |
| Total Medicare Allowed Amount | 38192.37 |
| Total Medicare Payment Amount | 26841.83 |
| Total Medicare Standardized Payment Amount | 29811.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 11 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 345 |
| Total Drug Medicare AllowedAmount | 112.99 |
| Total Drug Medicare PaymentAmount | 108.18 |
| Total Drug Medicare Standardized Payment Amount | 108.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 528 |
| Number Of Medicare Beneficiaries With Medical Services | 161 |
| Total Medical Submitted Charge Amount | 90339 |
| Total Medical Medicare Allowed Amount | 38079.38 |
| Total Medical Medicare Payment Amount | 26733.65 |
| Total Medical Medicare Standardized Payment Amount | 29703.04 |
| Average Age Of Beneficiaries | 87 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 26 |
| Number Of Beneficiaries Age Greater 84 | 121 |
| Number Of Female Beneficiaries | 122 |
| Number Of Male Beneficiaries | 39 |
| Number Of Non Hispanic White Beneficiaries | 147 |
| 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 | 130 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 61 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7765 |