| National Provider Identifier [NPI]: | 1174785109 |
| Last Name Of The Provider | RAFFERTY |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 134 W BROAD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | FALLS CHURCH |
| Zip Code Of The Provider | 220464201 |
| 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 | 19 |
| Number Of Services | 104 |
| Number Of Medicare Beneficiaries | 61 |
| Total Submitted Charge Amount | 4409.67 |
| Total Medicare Allowed Amount | 3944.46 |
| Total Medicare Payment Amount | 3164.74 |
| Total Medicare Standardized Payment Amount | 3584.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 1143.67 |
| Total Drug Medicare AllowedAmount | 1025.11 |
| Total Drug Medicare PaymentAmount | 1004.41 |
| Total Drug Medicare Standardized Payment Amount | 1004.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 11 |
| Number Of Medical Services | 70 |
| Number Of Medicare Beneficiaries With Medical Services | 61 |
| Total Medical Submitted Charge Amount | 3266 |
| Total Medical Medicare Allowed Amount | 2919.35 |
| Total Medical Medicare Payment Amount | 2160.33 |
| Total Medical Medicare Standardized Payment Amount | 2580.17 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 32 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 35 |
| Number Of Male Beneficiaries | 26 |
| 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 | 61 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 0 |
| 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 | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8416 |