National Provider Identifier [NPI]: |
1790847721 |
Last Name Of The Provider |
SMITH |
First Name Of The Provider |
CAROL |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
NP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
505 MAIN ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
NORTHPORT |
Zip Code Of The Provider |
117681954 |
State Code Of The Provider |
NY |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Certified Clinical Nurse Specialist |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
5 |
Number Of Services |
76 |
Number Of Medicare Beneficiaries |
40 |
Total Submitted Charge Amount |
48675.32 |
Total Medicare Allowed Amount |
5688.09 |
Total Medicare Payment Amount |
4405.05 |
Total Medicare Standardized Payment Amount |
4643.36 |
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 |
5 |
Number Of Medical Services |
76 |
Number Of Medicare Beneficiaries With Medical Services |
40 |
Total Medical Submitted Charge Amount |
48675.32 |
Total Medical Medicare Allowed Amount |
5688.09 |
Total Medical Medicare Payment Amount |
4405.05 |
Total Medical Medicare Standardized Payment Amount |
4643.36 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
13 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
12 |
Number Of Female Beneficiaries |
19 |
Number Of Male Beneficiaries |
21 |
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 |
25 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
15 |
Percent Of With Atrial Fibrillation |
30 |
Percent Of With Alzheimers Disease or Dementia |
55 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
60 |
Percent Of With Chronic Kidney Disease |
35 |
Percent Of With Chronic Obstructive Pulmonary Disease |
50 |
Percent Of With Depression |
73 |
Percent Of With Diabetes |
58 |
Percent Of With Hyperlipidemia |
70 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
75 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
38 |
Percent Of With Stroke |
28 |
Average HCC Risk Score Of Beneficiaries |
2.5287 |