| National Provider Identifier [NPI]: | 1093788598 |
| Last Name Of The Provider | THOMPSON |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7124 COMMONS DR |
| Street Address 2 Of The Provider | SUITE C |
| City Of The Provider | CHEYENNE |
| Zip Code Of The Provider | 820092620 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 326 |
| Number Of Medicare Beneficiaries | 185 |
| Total Submitted Charge Amount | 37490.01 |
| Total Medicare Allowed Amount | 16175.49 |
| Total Medicare Payment Amount | 10443.85 |
| Total Medicare Standardized Payment Amount | 12638.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 16 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 610 |
| Total Drug Medicare AllowedAmount | 326.7 |
| Total Drug Medicare PaymentAmount | 230.89 |
| Total Drug Medicare Standardized Payment Amount | 230.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 310 |
| Number Of Medicare Beneficiaries With Medical Services | 185 |
| Total Medical Submitted Charge Amount | 36880.01 |
| Total Medical Medicare Allowed Amount | 15848.79 |
| Total Medical Medicare Payment Amount | 10212.96 |
| Total Medical Medicare Standardized Payment Amount | 12407.81 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 104 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 122 |
| Number Of Male Beneficiaries | 63 |
| Number Of Non Hispanic White Beneficiaries | 173 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 173 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 12 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7121 |