| National Provider Identifier [NPI]: | 1003181371 |
| Last Name Of The Provider | BEZUAYEHU |
| First Name Of The Provider | FREHIWOT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | FNP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2101 W. SPRING CREEK PKWY |
| Street Address 2 Of The Provider | MINUTE CLINIC |
| City Of The Provider | PLANO |
| Zip Code Of The Provider | 75023 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 249 |
| Number Of Medicare Beneficiaries | 134 |
| Total Submitted Charge Amount | 10164.12 |
| Total Medicare Allowed Amount | 9447.66 |
| Total Medicare Payment Amount | 7703.36 |
| Total Medicare Standardized Payment Amount | 8850.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 88 |
| Number Of Medicare Beneficiaries With Drug Services | 83 |
| Total Drug Submitted ChargeAmount | 2852.12 |
| Total Drug Medicare AllowedAmount | 2852.12 |
| Total Drug Medicare PaymentAmount | 2795.06 |
| Total Drug Medicare Standardized Payment Amount | 2795.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 11 |
| Number Of Medical Services | 161 |
| Number Of Medicare Beneficiaries With Medical Services | 133 |
| Total Medical Submitted Charge Amount | 7312 |
| Total Medical Medicare Allowed Amount | 6595.54 |
| Total Medical Medicare Payment Amount | 4908.3 |
| Total Medical Medicare Standardized Payment Amount | 6055.78 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | 43 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 79 |
| Number Of Male Beneficiaries | 55 |
| Number Of Non Hispanic White Beneficiaries | 120 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7645 |