| National Provider Identifier [NPI]: | 1679789291 |
| Last Name Of The Provider | ERVIN |
| First Name Of The Provider | DENIM |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 101 E TERRI DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | VALLIANT |
| Zip Code Of The Provider | 747646801 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 655 |
| Number Of Medicare Beneficiaries | 136 |
| Total Submitted Charge Amount | 82615.32 |
| Total Medicare Allowed Amount | 22599.34 |
| Total Medicare Payment Amount | 16247.83 |
| Total Medicare Standardized Payment Amount | 20743.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 174 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 421.29 |
| Total Drug Medicare AllowedAmount | 155.61 |
| Total Drug Medicare PaymentAmount | 87.71 |
| Total Drug Medicare Standardized Payment Amount | 87.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 481 |
| Number Of Medicare Beneficiaries With Medical Services | 136 |
| Total Medical Submitted Charge Amount | 82194.03 |
| Total Medical Medicare Allowed Amount | 22443.73 |
| Total Medical Medicare Payment Amount | 16160.12 |
| Total Medical Medicare Standardized Payment Amount | 20655.52 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 45 |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 85 |
| Number Of Male Beneficiaries | 51 |
| Number Of Non Hispanic White Beneficiaries | 103 |
| Number Of Black or African American Beneficiaries | 15 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 18 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 66 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 70 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 35 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 48 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 22 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.717 |