| National Provider Identifier [NPI]: | 1023040920 |
| Last Name Of The Provider | DOUGHTY |
| First Name Of The Provider | LANA |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | RNCS, APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 85 EASTERN AVE |
| Street Address 2 Of The Provider | SUITE 206 |
| City Of The Provider | GLOUCESTER |
| Zip Code Of The Provider | 019301869 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Certified Clinical Nurse Specialist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 4 |
| Number Of Services | 805 |
| Number Of Medicare Beneficiaries | 179 |
| Total Submitted Charge Amount | 76295 |
| Total Medicare Allowed Amount | 54989.77 |
| Total Medicare Payment Amount | 37023.76 |
| Total Medicare Standardized Payment Amount | 44312.06 |
| 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 | 4 |
| Number Of Medical Services | 805 |
| Number Of Medicare Beneficiaries With Medical Services | 179 |
| Total Medical Submitted Charge Amount | 76295 |
| Total Medical Medicare Allowed Amount | 54989.77 |
| Total Medical Medicare Payment Amount | 37023.76 |
| Total Medical Medicare Standardized Payment Amount | 44312.06 |
| Average Age Of Beneficiaries | 50 |
| Number Of Beneficiaries Age Less65 | 150 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 79 |
| Number Of Non Hispanic White Beneficiaries | 162 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 25 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 8 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 18 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0181 |