| National Provider Identifier [NPI]: | 1760813430 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | JANE |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | NP-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 74 BARIBEAU DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | BRUNSWICK |
| Zip Code Of The Provider | 040113218 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 811 |
| Number Of Medicare Beneficiaries | 296 |
| Total Submitted Charge Amount | 71480.5 |
| Total Medicare Allowed Amount | 35340.55 |
| Total Medicare Payment Amount | 28383.84 |
| Total Medicare Standardized Payment Amount | 32930.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 538.5 |
| Total Drug Medicare AllowedAmount | 428.52 |
| Total Drug Medicare PaymentAmount | 406.84 |
| Total Drug Medicare Standardized Payment Amount | 406.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 789 |
| Number Of Medicare Beneficiaries With Medical Services | 296 |
| Total Medical Submitted Charge Amount | 70942 |
| Total Medical Medicare Allowed Amount | 34912.03 |
| Total Medical Medicare Payment Amount | 27977 |
| Total Medical Medicare Standardized Payment Amount | 32523.54 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 109 |
| Number Of Beneficiaries Age 75 to 84 | 98 |
| Number Of Beneficiaries Age Greater 84 | 48 |
| Number Of Female Beneficiaries | 195 |
| Number Of Male Beneficiaries | 101 |
| 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 | 235 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8861 |