| National Provider Identifier [NPI]: | 1578688560 |
| Last Name Of The Provider | BOURKE |
| First Name Of The Provider | LYDIA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | N.P. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2494 S ROCHESTER RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROCHESTER HILLS |
| Zip Code Of The Provider | 483073817 |
| 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 | 6 |
| Number Of Services | 1030 |
| Number Of Medicare Beneficiaries | 348 |
| Total Submitted Charge Amount | 115855 |
| Total Medicare Allowed Amount | 62356.44 |
| Total Medicare Payment Amount | 48888.22 |
| Total Medicare Standardized Payment Amount | 55643.49 |
| 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 | 6 |
| Number Of Medical Services | 1030 |
| Number Of Medicare Beneficiaries With Medical Services | 348 |
| Total Medical Submitted Charge Amount | 115855 |
| Total Medical Medicare Allowed Amount | 62356.44 |
| Total Medical Medicare Payment Amount | 48888.22 |
| Total Medical Medicare Standardized Payment Amount | 55643.49 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 73 |
| Number Of Beneficiaries Age 65 to 74 | 94 |
| Number Of Beneficiaries Age 75 to 84 | 108 |
| Number Of Beneficiaries Age Greater 84 | 73 |
| Number Of Female Beneficiaries | 199 |
| Number Of Male Beneficiaries | 149 |
| Number Of Non Hispanic White Beneficiaries | 194 |
| 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 | 209 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 139 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 41 |
| Percent Of With Asthma | 25 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 68 |
| Percent Of With Chronic Kidney Disease | 72 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 58 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 63 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 65 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 22 |
| Average HCC Risk Score Of Beneficiaries | 3.7914 |