National Provider Identifier [NPI]: |
1144555384 |
Last Name Of The Provider |
BURLESON |
First Name Of The Provider |
BRADEN |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
AA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2000 DAN PROCTOR DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
SAINT MARYS |
Zip Code Of The Provider |
315583810 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Anesthesiologist Assistants |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
43 |
Number Of Services |
213 |
Number Of Medicare Beneficiaries |
211 |
Total Submitted Charge Amount |
172710.54 |
Total Medicare Allowed Amount |
29345.24 |
Total Medicare Payment Amount |
22838.75 |
Total Medicare Standardized Payment Amount |
23930.88 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
43 |
Number Of Medical Services |
213 |
Number Of Medicare Beneficiaries With Medical Services |
211 |
Total Medical Submitted Charge Amount |
172710.54 |
Total Medical Medicare Allowed Amount |
29345.24 |
Total Medical Medicare Payment Amount |
22838.75 |
Total Medical Medicare Standardized Payment Amount |
23930.88 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
105 |
Number Of Beneficiaries Age 75 to 84 |
80 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
99 |
Number Of Male Beneficiaries |
112 |
Number Of Non Hispanic White Beneficiaries |
198 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
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 |
22 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
21 |
Percent Of With Heart Failure |
20 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
20 |
Percent Of With Hyperlipidemia |
72 |
Percent Of With Hypertension |
74 |
Percent Of With Ischemic Heart Disease |
41 |
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 |
1.0643 |