| National Provider Identifier [NPI]: | 1639286057 |
| Last Name Of The Provider | TEAGARDEN |
| First Name Of The Provider | DIANE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | NP, APRN-BC, MSN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12 EXECUTIVE PARK DR NE |
| Street Address 2 Of The Provider | 4TH FLOOR |
| City Of The Provider | ATLANTA |
| Zip Code Of The Provider | 303292206 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 8 |
| Number Of Services | 396 |
| Number Of Medicare Beneficiaries | 232 |
| Total Submitted Charge Amount | 121927 |
| Total Medicare Allowed Amount | 37370.99 |
| Total Medicare Payment Amount | 25710.21 |
| Total Medicare Standardized Payment Amount | 30865.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 8 |
| Number Of Medical Services | 396 |
| Number Of Medicare Beneficiaries With Medical Services | 232 |
| Total Medical Submitted Charge Amount | 121927 |
| Total Medical Medicare Allowed Amount | 37370.99 |
| Total Medical Medicare Payment Amount | 25710.21 |
| Total Medical Medicare Standardized Payment Amount | 30865.95 |
| Average Age Of Beneficiaries | 50 |
| Number Of Beneficiaries Age Less65 | 179 |
| Number Of Beneficiaries Age 65 to 74 | 35 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 128 |
| Number Of Male Beneficiaries | 104 |
| Number Of Non Hispanic White Beneficiaries | 137 |
| 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 | 89 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 143 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 5 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 13 |
| Percent Of With Hyperlipidemia | 28 |
| Percent Of With Hypertension | 36 |
| Percent Of With Ischemic Heart Disease | 10 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 17 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.0576 |