| National Provider Identifier [NPI]: | 1942462379 |
| Last Name Of The Provider | LONG |
| First Name Of The Provider | DEBORAH |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | A.R.N.P. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8181 N CORNERSTONE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAYDEN LAKE |
| Zip Code Of The Provider | 838358752 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 685 |
| Number Of Medicare Beneficiaries | 171 |
| Total Submitted Charge Amount | 34385.97 |
| Total Medicare Allowed Amount | 28318.18 |
| Total Medicare Payment Amount | 19801.34 |
| Total Medicare Standardized Payment Amount | 25784.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 21 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 347.95 |
| Total Drug Medicare AllowedAmount | 347.91 |
| Total Drug Medicare PaymentAmount | 338.58 |
| Total Drug Medicare Standardized Payment Amount | 338.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 664 |
| Number Of Medicare Beneficiaries With Medical Services | 171 |
| Total Medical Submitted Charge Amount | 34038.02 |
| Total Medical Medicare Allowed Amount | 27970.27 |
| Total Medical Medicare Payment Amount | 19462.76 |
| Total Medical Medicare Standardized Payment Amount | 25445.97 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 75 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 112 |
| Number Of Male Beneficiaries | 59 |
| 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 | 132 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8985 |