National Provider Identifier [NPI]: |
1114914124 |
Last Name Of The Provider |
JACKSON |
First Name Of The Provider |
CYNTHIA |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
629D LOWTHER RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
LEWISBERRY |
Zip Code Of The Provider |
173399527 |
State Code Of The Provider |
PA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
110 |
Number Of Services |
1444 |
Number Of Medicare Beneficiaries |
1079 |
Total Submitted Charge Amount |
193614 |
Total Medicare Allowed Amount |
49614.46 |
Total Medicare Payment Amount |
37564 |
Total Medicare Standardized Payment Amount |
38738.43 |
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 |
110 |
Number Of Medical Services |
1444 |
Number Of Medicare Beneficiaries With Medical Services |
1079 |
Total Medical Submitted Charge Amount |
193614 |
Total Medical Medicare Allowed Amount |
49614.46 |
Total Medical Medicare Payment Amount |
37564 |
Total Medical Medicare Standardized Payment Amount |
38738.43 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
176 |
Number Of Beneficiaries Age 65 to 74 |
331 |
Number Of Beneficiaries Age 75 to 84 |
309 |
Number Of Beneficiaries Age Greater 84 |
263 |
Number Of Female Beneficiaries |
652 |
Number Of Male Beneficiaries |
427 |
Number Of Non Hispanic White Beneficiaries |
988 |
Number Of Black or African American Beneficiaries |
59 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
14 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
795 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
284 |
Percent Of With Atrial Fibrillation |
23 |
Percent Of With Alzheimers Disease or Dementia |
21 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
36 |
Percent Of With Chronic Kidney Disease |
43 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
39 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
68 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
49 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
12 |
Percent Of With Stroke |
15 |
Average HCC Risk Score Of Beneficiaries |
1.8272 |