| National Provider Identifier [NPI]: | 1366409179 |
| Last Name Of The Provider | DAUWALDER |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | FNP-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1211 21ST AVENUE SOUTH |
| Street Address 2 Of The Provider | SUITE 112 |
| City Of The Provider | NASHVILLE |
| Zip Code Of The Provider | 372321343 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 201 |
| Number Of Medicare Beneficiaries | 60 |
| Total Submitted Charge Amount | 12180 |
| Total Medicare Allowed Amount | 6608.86 |
| Total Medicare Payment Amount | 5122.5 |
| Total Medicare Standardized Payment Amount | 6030.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 72 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 744 |
| Total Drug Medicare AllowedAmount | 37.15 |
| Total Drug Medicare PaymentAmount | 29.15 |
| Total Drug Medicare Standardized Payment Amount | 29.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 129 |
| Number Of Medicare Beneficiaries With Medical Services | 60 |
| Total Medical Submitted Charge Amount | 11436 |
| Total Medical Medicare Allowed Amount | 6571.71 |
| Total Medical Medicare Payment Amount | 5093.35 |
| Total Medical Medicare Standardized Payment Amount | 6001.62 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 24 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 42 |
| Number Of Male Beneficiaries | 18 |
| 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 | 39 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| 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 | 20 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.083 |