| National Provider Identifier [NPI]: | 1558646901 |
| Last Name Of The Provider | HENDRICKSON |
| First Name Of The Provider | SANDRA |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 604 RIVERSIDE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | WAYCROSS |
| Zip Code Of The Provider | 315015323 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 6 |
| Number Of Services | 153 |
| Number Of Medicare Beneficiaries | 53 |
| Total Submitted Charge Amount | 6410.98 |
| Total Medicare Allowed Amount | 5316.99 |
| Total Medicare Payment Amount | 4006.22 |
| Total Medicare Standardized Payment Amount | 4883.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 21 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 630 |
| Total Drug Medicare AllowedAmount | 353.54 |
| Total Drug Medicare PaymentAmount | 346.4 |
| Total Drug Medicare Standardized Payment Amount | 346.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 5 |
| Number Of Medical Services | 132 |
| Number Of Medicare Beneficiaries With Medical Services | 53 |
| Total Medical Submitted Charge Amount | 5780.98 |
| Total Medical Medicare Allowed Amount | 4963.45 |
| Total Medical Medicare Payment Amount | 3659.82 |
| Total Medical Medicare Standardized Payment Amount | 4537.46 |
| Average Age Of Beneficiaries | 55 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | 0 |
| Number Of Female Beneficiaries | 20 |
| Number Of Male Beneficiaries | 33 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 38 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 0 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4606 |