National Provider Identifier [NPI]: |
1255500880 |
Last Name Of The Provider |
CORNELL |
First Name Of The Provider |
AMBER |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
ARNP-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
414 W ROBERTSON ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
BRANDON |
Zip Code Of The Provider |
335115010 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
20 |
Number Of Services |
160 |
Number Of Medicare Beneficiaries |
102 |
Total Submitted Charge Amount |
7424.51 |
Total Medicare Allowed Amount |
6715.99 |
Total Medicare Payment Amount |
4622.81 |
Total Medicare Standardized Payment Amount |
5485.64 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
50 |
Number Of Medicare Beneficiaries With Drug Services |
49 |
Total Drug Submitted ChargeAmount |
1629.51 |
Total Drug Medicare AllowedAmount |
1510.95 |
Total Drug Medicare PaymentAmount |
1479.75 |
Total Drug Medicare Standardized Payment Amount |
1479.75 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
13 |
Number Of Medical Services |
110 |
Number Of Medicare Beneficiaries With Medical Services |
102 |
Total Medical Submitted Charge Amount |
5795 |
Total Medical Medicare Allowed Amount |
5205.04 |
Total Medical Medicare Payment Amount |
3143.06 |
Total Medical Medicare Standardized Payment Amount |
4005.89 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
48 |
Number Of Beneficiaries Age 75 to 84 |
28 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
65 |
Number Of Male Beneficiaries |
37 |
Number Of Non Hispanic White Beneficiaries |
91 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
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 |
13 |
Percent Of With Asthma |
|
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
13 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
25 |
Percent Of With Hyperlipidemia |
43 |
Percent Of With Hypertension |
60 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8193 |