| National Provider Identifier [NPI]: | 1427393776 |
| Last Name Of The Provider | TELLMAN |
| First Name Of The Provider | SHELLY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14973 W BELL RD |
| Street Address 2 Of The Provider | #100 |
| City Of The Provider | SURPRISE |
| Zip Code Of The Provider | 853743236 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 157 |
| Number Of Medicare Beneficiaries | 65 |
| Total Submitted Charge Amount | 12175.76 |
| Total Medicare Allowed Amount | 10215.99 |
| Total Medicare Payment Amount | 8016.33 |
| Total Medicare Standardized Payment Amount | 9525.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 23 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 431 |
| Total Drug Medicare AllowedAmount | 238.12 |
| Total Drug Medicare PaymentAmount | 229.99 |
| Total Drug Medicare Standardized Payment Amount | 229.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 134 |
| Number Of Medicare Beneficiaries With Medical Services | 65 |
| Total Medical Submitted Charge Amount | 11744.76 |
| Total Medical Medicare Allowed Amount | 9977.87 |
| Total Medical Medicare Payment Amount | 7786.34 |
| Total Medical Medicare Standardized Payment Amount | 9295.99 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 42 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 43 |
| Number Of Male Beneficiaries | 22 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 0 |
| 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 | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8686 |