| National Provider Identifier [NPI]: | 1568473270 |
| Last Name Of The Provider | BRISTER |
| First Name Of The Provider | JACKIE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | F.N.P. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1017 DELAWARE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MCCOMB |
| Zip Code Of The Provider | 396483827 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 81 |
| Number Of Services | 3733 |
| Number Of Medicare Beneficiaries | 693 |
| Total Submitted Charge Amount | 219945.05 |
| Total Medicare Allowed Amount | 103873.76 |
| Total Medicare Payment Amount | 69772.77 |
| Total Medicare Standardized Payment Amount | 92402.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 1269 |
| Number Of Medicare Beneficiaries With Drug Services | 402 |
| Total Drug Submitted ChargeAmount | 20399.85 |
| Total Drug Medicare AllowedAmount | 4652.74 |
| Total Drug Medicare PaymentAmount | 3160.15 |
| Total Drug Medicare Standardized Payment Amount | 3160.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 2464 |
| Number Of Medicare Beneficiaries With Medical Services | 693 |
| Total Medical Submitted Charge Amount | 199545.2 |
| Total Medical Medicare Allowed Amount | 99221.02 |
| Total Medical Medicare Payment Amount | 66612.62 |
| Total Medical Medicare Standardized Payment Amount | 89242.36 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 83 |
| Number Of Beneficiaries Age 65 to 74 | 349 |
| Number Of Beneficiaries Age 75 to 84 | 208 |
| Number Of Beneficiaries Age Greater 84 | 53 |
| Number Of Female Beneficiaries | 400 |
| Number Of Male Beneficiaries | 293 |
| Number Of Non Hispanic White Beneficiaries | 598 |
| 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 | 622 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 71 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9441 |