| National Provider Identifier [NPI]: | 1447345632 |
| Last Name Of The Provider | RIDGE |
| First Name Of The Provider | TERRY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | NP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4880 CENTURY PLAZA RD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462545469 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 257 |
| Number Of Medicare Beneficiaries | 110 |
| Total Submitted Charge Amount | 13973 |
| Total Medicare Allowed Amount | 7931.55 |
| Total Medicare Payment Amount | 6244.82 |
| Total Medicare Standardized Payment Amount | 7690.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 29 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 1250 |
| Total Drug Medicare AllowedAmount | 977.81 |
| Total Drug Medicare PaymentAmount | 957.83 |
| Total Drug Medicare Standardized Payment Amount | 957.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 8 |
| Number Of Medical Services | 228 |
| Number Of Medicare Beneficiaries With Medical Services | 109 |
| Total Medical Submitted Charge Amount | 12723 |
| Total Medical Medicare Allowed Amount | 6953.74 |
| Total Medical Medicare Payment Amount | 5286.99 |
| Total Medical Medicare Standardized Payment Amount | 6733.07 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 60 |
| Number Of Beneficiaries Age 75 to 84 | 36 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 59 |
| Number Of Male Beneficiaries | 51 |
| Number Of Non Hispanic White Beneficiaries | 82 |
| 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 | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 75 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0418 |