National Provider Identifier [NPI]: |
1528256807 |
Last Name Of The Provider |
SPROUSE |
First Name Of The Provider |
DAVID |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
5225 CIRQUE DR W |
Street Address 2 Of The Provider |
200 |
City Of The Provider |
UNIVERSITY PLACE |
Zip Code Of The Provider |
984673604 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
46 |
Number Of Services |
3495 |
Number Of Medicare Beneficiaries |
583 |
Total Submitted Charge Amount |
258714 |
Total Medicare Allowed Amount |
163255.37 |
Total Medicare Payment Amount |
112383.85 |
Total Medicare Standardized Payment Amount |
135381.7 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
54 |
Number Of Medicare Beneficiaries With Drug Services |
40 |
Total Drug Submitted ChargeAmount |
7037 |
Total Drug Medicare AllowedAmount |
6442.48 |
Total Drug Medicare PaymentAmount |
4859.28 |
Total Drug Medicare Standardized Payment Amount |
4859.28 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
44 |
Number Of Medical Services |
3441 |
Number Of Medicare Beneficiaries With Medical Services |
583 |
Total Medical Submitted Charge Amount |
251677 |
Total Medical Medicare Allowed Amount |
156812.89 |
Total Medical Medicare Payment Amount |
107524.57 |
Total Medical Medicare Standardized Payment Amount |
130522.42 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
56 |
Number Of Beneficiaries Age 65 to 74 |
267 |
Number Of Beneficiaries Age 75 to 84 |
193 |
Number Of Beneficiaries Age Greater 84 |
67 |
Number Of Female Beneficiaries |
283 |
Number Of Male Beneficiaries |
300 |
Number Of Non Hispanic White Beneficiaries |
523 |
Number Of Black or African American Beneficiaries |
19 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
16 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
11 |
Number Of Beneficiaries With Medicare Only Entitlement |
537 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
46 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
5 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
15 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
48 |
Percent Of With Ischemic Heart Disease |
21 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9169 |