| National Provider Identifier [NPI]: | 1730440363 |
| Last Name Of The Provider | KING |
| First Name Of The Provider | KATHLEEN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2740 PROSPERITY AVE |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | FAIRFAX |
| Zip Code Of The Provider | 220314353 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 429 |
| Number Of Medicare Beneficiaries | 74 |
| Total Submitted Charge Amount | 49832 |
| Total Medicare Allowed Amount | 20282.99 |
| Total Medicare Payment Amount | 14368.75 |
| Total Medicare Standardized Payment Amount | 14769.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 195 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 5541 |
| Total Drug Medicare AllowedAmount | 2606.03 |
| Total Drug Medicare PaymentAmount | 2546.05 |
| Total Drug Medicare Standardized Payment Amount | 2546.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 234 |
| Number Of Medicare Beneficiaries With Medical Services | 74 |
| Total Medical Submitted Charge Amount | 44291 |
| Total Medical Medicare Allowed Amount | 17676.96 |
| Total Medical Medicare Payment Amount | 11822.7 |
| Total Medical Medicare Standardized Payment Amount | 12223.53 |
| Average Age Of Beneficiaries | 54 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 11 |
| Number Of Beneficiaries Age 75 to 84 | 0 |
| Number Of Beneficiaries Age Greater 84 | 0 |
| Number Of Female Beneficiaries | 24 |
| Number Of Male Beneficiaries | 50 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 43 |
| 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 | 38 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 36 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4014 |