National Provider Identifier [NPI]: |
1679509012 |
Last Name Of The Provider |
ELLIOTT |
First Name Of The Provider |
DARLENE |
Middle Initial Of The Provider |
N |
Credentials Of The Provider |
CNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
200 EMILIO LOPEZ RD NW |
Street Address 2 Of The Provider |
|
City Of The Provider |
LOS LUNAS |
Zip Code Of The Provider |
870316818 |
State Code Of The Provider |
NM |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
10 |
Number Of Services |
349 |
Number Of Medicare Beneficiaries |
181 |
Total Submitted Charge Amount |
23056 |
Total Medicare Allowed Amount |
15515.68 |
Total Medicare Payment Amount |
10510.71 |
Total Medicare Standardized Payment Amount |
13072.39 |
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 |
10 |
Number Of Medical Services |
349 |
Number Of Medicare Beneficiaries With Medical Services |
181 |
Total Medical Submitted Charge Amount |
23056 |
Total Medical Medicare Allowed Amount |
15515.68 |
Total Medical Medicare Payment Amount |
10510.71 |
Total Medical Medicare Standardized Payment Amount |
13072.39 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
40 |
Number Of Beneficiaries Age 65 to 74 |
73 |
Number Of Beneficiaries Age 75 to 84 |
52 |
Number Of Beneficiaries Age Greater 84 |
16 |
Number Of Female Beneficiaries |
112 |
Number Of Male Beneficiaries |
69 |
Number Of Non Hispanic White Beneficiaries |
112 |
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 |
134 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
47 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
27 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
28 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
53 |
Percent Of With Hypertension |
63 |
Percent Of With Ischemic Heart Disease |
23 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.1583 |