| National Provider Identifier [NPI]: | 1982797254 |
| Last Name Of The Provider | WATSON |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1506 W REYNOLDS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PONTIAC |
| Zip Code Of The Provider | 61764 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 350 |
| Number Of Medicare Beneficiaries | 91 |
| Total Submitted Charge Amount | 44382 |
| Total Medicare Allowed Amount | 19987.07 |
| Total Medicare Payment Amount | 13264.07 |
| Total Medicare Standardized Payment Amount | 17043.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 46 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 1567 |
| Total Drug Medicare AllowedAmount | 1055.71 |
| Total Drug Medicare PaymentAmount | 1029.65 |
| Total Drug Medicare Standardized Payment Amount | 1029.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 304 |
| Number Of Medicare Beneficiaries With Medical Services | 91 |
| Total Medical Submitted Charge Amount | 42815 |
| Total Medical Medicare Allowed Amount | 18931.36 |
| Total Medical Medicare Payment Amount | 12234.42 |
| Total Medical Medicare Standardized Payment Amount | 16014.03 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 39 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 69 |
| Number Of Male Beneficiaries | 22 |
| 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 | 71 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| 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 | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.8865 |