| National Provider Identifier [NPI]: | 1699081281 |
| Last Name Of The Provider | MYSEN |
| First Name Of The Provider | KATIE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | N.P. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 809 W DRYDEN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | METAMORA |
| Zip Code Of The Provider | 484558961 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 329 |
| Number Of Medicare Beneficiaries | 190 |
| Total Submitted Charge Amount | 23397 |
| Total Medicare Allowed Amount | 15759.73 |
| Total Medicare Payment Amount | 10377.95 |
| Total Medicare Standardized Payment Amount | 12693.05 |
| 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 | 12 |
| Number Of Medical Services | 329 |
| Number Of Medicare Beneficiaries With Medical Services | 190 |
| Total Medical Submitted Charge Amount | 23397 |
| Total Medical Medicare Allowed Amount | 15759.73 |
| Total Medical Medicare Payment Amount | 10377.95 |
| Total Medical Medicare Standardized Payment Amount | 12693.05 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 79 |
| Number Of Beneficiaries Age 65 to 74 | 67 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 118 |
| Number Of Male Beneficiaries | 72 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 106 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 84 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4728 |