| National Provider Identifier [NPI]: | 1164590253 |
| Last Name Of The Provider | GORDON |
| First Name Of The Provider | JERLENA |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | APRN-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3810 WINCHESTER RD |
| Street Address 2 Of The Provider | SOUTHEAST MENTAL HEALTH CENTER |
| City Of The Provider | MEMPHIS |
| Zip Code Of The Provider | 381186045 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 6 |
| Number Of Services | 468 |
| Number Of Medicare Beneficiaries | 250 |
| Total Submitted Charge Amount | 33040 |
| Total Medicare Allowed Amount | 26438.62 |
| Total Medicare Payment Amount | 15025.35 |
| Total Medicare Standardized Payment Amount | 22001.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 16 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 480 |
| Total Drug Medicare AllowedAmount | 66.09 |
| Total Drug Medicare PaymentAmount | 45.84 |
| Total Drug Medicare Standardized Payment Amount | 45.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 4 |
| Number Of Medical Services | 452 |
| Number Of Medicare Beneficiaries With Medical Services | 248 |
| Total Medical Submitted Charge Amount | 32560 |
| Total Medical Medicare Allowed Amount | 26372.53 |
| Total Medical Medicare Payment Amount | 14979.51 |
| Total Medical Medicare Standardized Payment Amount | 21955.86 |
| Average Age Of Beneficiaries | 49 |
| Number Of Beneficiaries Age Less65 | 227 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 117 |
| Number Of Male Beneficiaries | 133 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 217 |
| 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 | 13 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 237 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 26 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 10 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 18 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 72 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1445 |