| National Provider Identifier [NPI]: | 1760729750 |
| Last Name Of The Provider | GRACE |
| First Name Of The Provider | NIKKI |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 302 E JAMES LEE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CRESTVIEW |
| Zip Code Of The Provider | 325392827 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 578 |
| Number Of Medicare Beneficiaries | 288 |
| Total Submitted Charge Amount | 22058.81 |
| Total Medicare Allowed Amount | 19846.44 |
| Total Medicare Payment Amount | 16496.53 |
| Total Medicare Standardized Payment Amount | 18625.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 219 |
| Number Of Medicare Beneficiaries With Drug Services | 202 |
| Total Drug Submitted ChargeAmount | 7385.81 |
| Total Drug Medicare AllowedAmount | 6970.85 |
| Total Drug Medicare PaymentAmount | 6651.42 |
| Total Drug Medicare Standardized Payment Amount | 6651.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 359 |
| Number Of Medicare Beneficiaries With Medical Services | 283 |
| Total Medical Submitted Charge Amount | 14673 |
| Total Medical Medicare Allowed Amount | 12875.59 |
| Total Medical Medicare Payment Amount | 9845.11 |
| Total Medical Medicare Standardized Payment Amount | 11974.53 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 153 |
| Number Of Beneficiaries Age 75 to 84 | 76 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 181 |
| Number Of Male Beneficiaries | 107 |
| Number Of Non Hispanic White Beneficiaries | 268 |
| 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 | 251 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.918 |