| National Provider Identifier [NPI]: | 1043252174 |
| Last Name Of The Provider | CAMPBELL |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | NP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1367 DOMINION PLZ |
| Street Address 2 Of The Provider | |
| City Of The Provider | TYLER |
| Zip Code Of The Provider | 757031013 |
| 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 | 54 |
| Number Of Services | 5842 |
| Number Of Medicare Beneficiaries | 1294 |
| Total Submitted Charge Amount | 545490.73 |
| Total Medicare Allowed Amount | 225887.95 |
| Total Medicare Payment Amount | 163823.87 |
| Total Medicare Standardized Payment Amount | 201524.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 743 |
| Number Of Medicare Beneficiaries With Drug Services | 101 |
| Total Drug Submitted ChargeAmount | 9099.13 |
| Total Drug Medicare AllowedAmount | 1969.92 |
| Total Drug Medicare PaymentAmount | 1422.93 |
| Total Drug Medicare Standardized Payment Amount | 1422.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 5099 |
| Number Of Medicare Beneficiaries With Medical Services | 1294 |
| Total Medical Submitted Charge Amount | 536391.6 |
| Total Medical Medicare Allowed Amount | 223918.03 |
| Total Medical Medicare Payment Amount | 162400.94 |
| Total Medical Medicare Standardized Payment Amount | 200101.74 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 61 |
| Number Of Beneficiaries Age 65 to 74 | 512 |
| Number Of Beneficiaries Age 75 to 84 | 524 |
| Number Of Beneficiaries Age Greater 84 | 197 |
| Number Of Female Beneficiaries | 532 |
| Number Of Male Beneficiaries | 762 |
| Number Of Non Hispanic White Beneficiaries | 1237 |
| Number Of Black or African American Beneficiaries | 37 |
| 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 | 1209 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 85 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1147 |