| National Provider Identifier [NPI]: | 1720095896 |
| Last Name Of The Provider | EVANS |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1301 S ADAMS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | FULTON |
| Zip Code Of The Provider | 388438862 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 1421 |
| Number Of Medicare Beneficiaries | 214 |
| Total Submitted Charge Amount | 115645 |
| Total Medicare Allowed Amount | 56081.64 |
| Total Medicare Payment Amount | 37391.29 |
| Total Medicare Standardized Payment Amount | 49246.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 262 |
| Number Of Medicare Beneficiaries With Drug Services | 66 |
| Total Drug Submitted ChargeAmount | 6600 |
| Total Drug Medicare AllowedAmount | 1027.88 |
| Total Drug Medicare PaymentAmount | 766.93 |
| Total Drug Medicare Standardized Payment Amount | 766.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 1159 |
| Number Of Medicare Beneficiaries With Medical Services | 214 |
| Total Medical Submitted Charge Amount | 109045 |
| Total Medical Medicare Allowed Amount | 55053.76 |
| Total Medical Medicare Payment Amount | 36624.36 |
| Total Medical Medicare Standardized Payment Amount | 48479.35 |
| Average Age Of Beneficiaries | 60 |
| Number Of Beneficiaries Age Less65 | 120 |
| Number Of Beneficiaries Age 65 to 74 | 66 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 124 |
| Number Of Male Beneficiaries | 90 |
| Number Of Non Hispanic White Beneficiaries | 190 |
| 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 | 109 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 105 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 7 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9117 |