| National Provider Identifier [NPI]: | 1902121379 |
| Last Name Of The Provider | VASTINE |
| First Name Of The Provider | CLARENCE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | FNP-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3000 N LITCHFIELD RD |
| Street Address 2 Of The Provider | SUITE 120 |
| City Of The Provider | GOODYEAR |
| Zip Code Of The Provider | 853957802 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 323 |
| Number Of Medicare Beneficiaries | 116 |
| Total Submitted Charge Amount | 37893.92 |
| Total Medicare Allowed Amount | 21798.77 |
| Total Medicare Payment Amount | 14814.15 |
| Total Medicare Standardized Payment Amount | 18125.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 18 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 548.92 |
| Total Drug Medicare AllowedAmount | 379.63 |
| Total Drug Medicare PaymentAmount | 370.8 |
| Total Drug Medicare Standardized Payment Amount | 370.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 305 |
| Number Of Medicare Beneficiaries With Medical Services | 116 |
| Total Medical Submitted Charge Amount | 37345 |
| Total Medical Medicare Allowed Amount | 21419.14 |
| Total Medical Medicare Payment Amount | 14443.35 |
| Total Medical Medicare Standardized Payment Amount | 17754.28 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | 22 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 67 |
| Number Of Male Beneficiaries | 49 |
| Number Of Non Hispanic White Beneficiaries | 85 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 94 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2031 |