| National Provider Identifier [NPI]: | 1235419904 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | JONATHAN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | APN |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3534 MURFREESBORO PIKE |
| Street Address 2 Of The Provider | SUITE 104 |
| City Of The Provider | ANTIOCH |
| Zip Code Of The Provider | 370132583 |
| 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 | 66 |
| Number Of Services | 931 |
| Number Of Medicare Beneficiaries | 127 |
| Total Submitted Charge Amount | 55250 |
| Total Medicare Allowed Amount | 28266.92 |
| Total Medicare Payment Amount | 20189.47 |
| Total Medicare Standardized Payment Amount | 25899.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 436 |
| Number Of Medicare Beneficiaries With Drug Services | 68 |
| Total Drug Submitted ChargeAmount | 6578 |
| Total Drug Medicare AllowedAmount | 1288.32 |
| Total Drug Medicare PaymentAmount | 1141.01 |
| Total Drug Medicare Standardized Payment Amount | 1141.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 495 |
| Number Of Medicare Beneficiaries With Medical Services | 127 |
| Total Medical Submitted Charge Amount | 48672 |
| Total Medical Medicare Allowed Amount | 26978.6 |
| Total Medical Medicare Payment Amount | 19048.46 |
| Total Medical Medicare Standardized Payment Amount | 24758.84 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 51 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 82 |
| Number Of Male Beneficiaries | 45 |
| Number Of Non Hispanic White Beneficiaries | 74 |
| 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 | 103 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2061 |