| National Provider Identifier [NPI]: | 1063420230 |
| Last Name Of The Provider | DICKEN |
| First Name Of The Provider | KAREN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | APN/CNS |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1786 MOON LAKE BLVD |
| Street Address 2 Of The Provider | #104 |
| City Of The Provider | HOFFMAN ESTATES |
| Zip Code Of The Provider | 601695029 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Certified Clinical Nurse Specialist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 7 |
| Number Of Services | 1379 |
| Number Of Medicare Beneficiaries | 189 |
| Total Submitted Charge Amount | 255215 |
| Total Medicare Allowed Amount | 159140.83 |
| Total Medicare Payment Amount | 116838.23 |
| Total Medicare Standardized Payment Amount | 138587.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 7 |
| Number Of Medical Services | 1379 |
| Number Of Medicare Beneficiaries With Medical Services | 189 |
| Total Medical Submitted Charge Amount | 255215 |
| Total Medical Medicare Allowed Amount | 159140.83 |
| Total Medical Medicare Payment Amount | 116838.23 |
| Total Medical Medicare Standardized Payment Amount | 138587.68 |
| Average Age Of Beneficiaries | 85 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 114 |
| Number Of Female Beneficiaries | 140 |
| Number Of Male Beneficiaries | 49 |
| Number Of Non Hispanic White Beneficiaries | 172 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 94 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 95 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 48 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 1.8048 |