| National Provider Identifier [NPI]: | 1538120373 |
| Last Name Of The Provider | ELIZALDE |
| First Name Of The Provider | TRACEY |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | CRNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9 SAINT PAUL ST |
| Street Address 2 Of The Provider | 2ND FLOOR |
| City Of The Provider | BOONSBORO |
| Zip Code Of The Provider | 217131334 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 497 |
| Number Of Medicare Beneficiaries | 114 |
| Total Submitted Charge Amount | 48697.5 |
| Total Medicare Allowed Amount | 29057.44 |
| Total Medicare Payment Amount | 20890.05 |
| Total Medicare Standardized Payment Amount | 24789.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 31 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 1425 |
| Total Drug Medicare AllowedAmount | 855.05 |
| Total Drug Medicare PaymentAmount | 824.43 |
| Total Drug Medicare Standardized Payment Amount | 824.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 466 |
| Number Of Medicare Beneficiaries With Medical Services | 114 |
| Total Medical Submitted Charge Amount | 47272.5 |
| Total Medical Medicare Allowed Amount | 28202.39 |
| Total Medical Medicare Payment Amount | 20065.62 |
| Total Medical Medicare Standardized Payment Amount | 23964.92 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 58 |
| Number Of Beneficiaries Age 75 to 84 | 22 |
| Number Of Beneficiaries Age Greater 84 | 0 |
| Number Of Female Beneficiaries | 93 |
| Number Of Male Beneficiaries | 21 |
| 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 | 82 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| 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 | |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 12 |
| 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 | 0.8609 |