National Provider Identifier [NPI]: |
1144326778 |
Last Name Of The Provider |
BENADUM |
First Name Of The Provider |
DONNA |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
LCSW |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4045 NW 64TH ST |
Street Address 2 Of The Provider |
SUITE 520 |
City Of The Provider |
OKLAHOMA CITY |
Zip Code Of The Provider |
731161684 |
State Code Of The Provider |
OK |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Licensed Clinical Social Worker |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
3 |
Number Of Services |
4012 |
Number Of Medicare Beneficiaries |
76 |
Total Submitted Charge Amount |
265105 |
Total Medicare Allowed Amount |
191976.18 |
Total Medicare Payment Amount |
145873.89 |
Total Medicare Standardized Payment Amount |
149776.32 |
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 |
3 |
Number Of Medical Services |
4012 |
Number Of Medicare Beneficiaries With Medical Services |
76 |
Total Medical Submitted Charge Amount |
265105 |
Total Medical Medicare Allowed Amount |
191976.18 |
Total Medical Medicare Payment Amount |
145873.89 |
Total Medical Medicare Standardized Payment Amount |
149776.32 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
19 |
Number Of Beneficiaries Age 65 to 74 |
18 |
Number Of Beneficiaries Age 75 to 84 |
15 |
Number Of Beneficiaries Age Greater 84 |
24 |
Number Of Female Beneficiaries |
53 |
Number Of Male Beneficiaries |
23 |
Number Of Non Hispanic White Beneficiaries |
62 |
Number Of Black or African American Beneficiaries |
0 |
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
0 |
Number Of American Indian Alaska Native Beneficiaries |
14 |
Number Of Beneficiaries With Race Not Else where Classified |
0 |
Number Of Beneficiaries With Medicare Only Entitlement |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
68 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
42 |
Percent Of With Chronic Kidney Disease |
33 |
Percent Of With Chronic Obstructive Pulmonary Disease |
37 |
Percent Of With Depression |
75 |
Percent Of With Diabetes |
54 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
51 |
Percent Of With Osteoporosis |
17 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
41 |
Percent Of With Stroke |
14 |
Average HCC Risk Score Of Beneficiaries |
2.1788 |