National Provider Identifier [NPI]: |
1083603575 |
Last Name Of The Provider |
KIMBALL |
First Name Of The Provider |
DIANE |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
NP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
920 COUNTRY CLUB RD |
Street Address 2 Of The Provider |
SUITE 200A |
City Of The Provider |
EUGENE |
Zip Code Of The Provider |
974016024 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
69 |
Number Of Services |
1195 |
Number Of Medicare Beneficiaries |
188 |
Total Submitted Charge Amount |
112642 |
Total Medicare Allowed Amount |
37426.12 |
Total Medicare Payment Amount |
28572.01 |
Total Medicare Standardized Payment Amount |
34078.4 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
66 |
Number Of Medicare Beneficiaries With Drug Services |
42 |
Total Drug Submitted ChargeAmount |
1747 |
Total Drug Medicare AllowedAmount |
1189.5 |
Total Drug Medicare PaymentAmount |
1043.22 |
Total Drug Medicare Standardized Payment Amount |
1043.22 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
61 |
Number Of Medical Services |
1129 |
Number Of Medicare Beneficiaries With Medical Services |
188 |
Total Medical Submitted Charge Amount |
110895 |
Total Medical Medicare Allowed Amount |
36236.62 |
Total Medical Medicare Payment Amount |
27528.79 |
Total Medical Medicare Standardized Payment Amount |
33035.18 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
38 |
Number Of Beneficiaries Age 65 to 74 |
72 |
Number Of Beneficiaries Age 75 to 84 |
58 |
Number Of Beneficiaries Age Greater 84 |
20 |
Number Of Female Beneficiaries |
116 |
Number Of Male Beneficiaries |
72 |
Number Of Non Hispanic White Beneficiaries |
176 |
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 |
149 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
39 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
6 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
27 |
Percent Of With Diabetes |
21 |
Percent Of With Hyperlipidemia |
39 |
Percent Of With Hypertension |
43 |
Percent Of With Ischemic Heart Disease |
12 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
26 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8542 |