| National Provider Identifier [NPI]: | 1740278530 |
| Last Name Of The Provider | FOUTS |
| First Name Of The Provider | DIANE |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MSN,FNPC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 960 W WOOSTER ST |
| Street Address 2 Of The Provider | SUITE 105 |
| City Of The Provider | BOWLING GREEN |
| Zip Code Of The Provider | 434022644 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 498 |
| Number Of Medicare Beneficiaries | 128 |
| Total Submitted Charge Amount | 36807 |
| Total Medicare Allowed Amount | 28647.6 |
| Total Medicare Payment Amount | 19964.81 |
| Total Medicare Standardized Payment Amount | 25224.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 538 |
| Total Drug Medicare AllowedAmount | 231.03 |
| Total Drug Medicare PaymentAmount | 223.09 |
| Total Drug Medicare Standardized Payment Amount | 223.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 464 |
| Number Of Medicare Beneficiaries With Medical Services | 128 |
| Total Medical Submitted Charge Amount | 36269 |
| Total Medical Medicare Allowed Amount | 28416.57 |
| Total Medical Medicare Payment Amount | 19741.72 |
| Total Medical Medicare Standardized Payment Amount | 25001.89 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 51 |
| Number Of Beneficiaries Age 75 to 84 | 32 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 81 |
| Number Of Male Beneficiaries | 47 |
| 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 | 86 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 24 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1956 |