| National Provider Identifier [NPI]: | 1407002603 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | LORETTA |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | N.P |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 39 CUMBERLAND GAP PLZ |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAY |
| Zip Code Of The Provider | 407344536 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 762 |
| Number Of Medicare Beneficiaries | 307 |
| Total Submitted Charge Amount | 86408 |
| Total Medicare Allowed Amount | 30503.06 |
| Total Medicare Payment Amount | 19055.6 |
| Total Medicare Standardized Payment Amount | 25880.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 77 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 684 |
| Total Drug Medicare AllowedAmount | 273.11 |
| Total Drug Medicare PaymentAmount | 218.74 |
| Total Drug Medicare Standardized Payment Amount | 218.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 685 |
| Number Of Medicare Beneficiaries With Medical Services | 307 |
| Total Medical Submitted Charge Amount | 85724 |
| Total Medical Medicare Allowed Amount | 30229.95 |
| Total Medical Medicare Payment Amount | 18836.86 |
| Total Medical Medicare Standardized Payment Amount | 25661.49 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 118 |
| Number Of Beneficiaries Age 65 to 74 | 109 |
| Number Of Beneficiaries Age 75 to 84 | 65 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 183 |
| Number Of Male Beneficiaries | 124 |
| 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 | 130 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 177 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.04 |