| National Provider Identifier [NPI]: | 1477530814 |
| Last Name Of The Provider | WILLER |
| First Name Of The Provider | RENEE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4581 GRAVOIS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | HOUSE SPRINGS |
| Zip Code Of The Provider | 630511374 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 747 |
| Number Of Medicare Beneficiaries | 109 |
| Total Submitted Charge Amount | 58663.5 |
| Total Medicare Allowed Amount | 31271.61 |
| Total Medicare Payment Amount | 22308.38 |
| Total Medicare Standardized Payment Amount | 27849.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 62 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 490.5 |
| Total Drug Medicare AllowedAmount | 236.56 |
| Total Drug Medicare PaymentAmount | 205.85 |
| Total Drug Medicare Standardized Payment Amount | 205.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 685 |
| Number Of Medicare Beneficiaries With Medical Services | 109 |
| Total Medical Submitted Charge Amount | 58173 |
| Total Medical Medicare Allowed Amount | 31035.05 |
| Total Medical Medicare Payment Amount | 22102.53 |
| Total Medical Medicare Standardized Payment Amount | 27643.46 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 44 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 62 |
| Number Of Male Beneficiaries | 47 |
| 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 | 72 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| 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 | 14 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.196 |