National Provider Identifier [NPI]: |
1396971941 |
Last Name Of The Provider |
LOVELL |
First Name Of The Provider |
ANDREW |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
PA |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1302 S ROGERS ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
BLOOMINGTON |
Zip Code Of The Provider |
474034752 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
36 |
Number Of Services |
343 |
Number Of Medicare Beneficiaries |
100 |
Total Submitted Charge Amount |
238594 |
Total Medicare Allowed Amount |
16984.03 |
Total Medicare Payment Amount |
12244.52 |
Total Medicare Standardized Payment Amount |
13470.92 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
199 |
Number Of Medicare Beneficiaries With Drug Services |
23 |
Total Drug Submitted ChargeAmount |
9860 |
Total Drug Medicare AllowedAmount |
5170.3 |
Total Drug Medicare PaymentAmount |
3678.87 |
Total Drug Medicare Standardized Payment Amount |
3678.87 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
33 |
Number Of Medical Services |
144 |
Number Of Medicare Beneficiaries With Medical Services |
100 |
Total Medical Submitted Charge Amount |
228734 |
Total Medical Medicare Allowed Amount |
11813.73 |
Total Medical Medicare Payment Amount |
8565.65 |
Total Medical Medicare Standardized Payment Amount |
9792.05 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
42 |
Number Of Beneficiaries Age 75 to 84 |
31 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
72 |
Number Of Male Beneficiaries |
28 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
82 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
18 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
11 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
35 |
Percent Of With Diabetes |
30 |
Percent Of With Hyperlipidemia |
66 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
39 |
Percent Of With Osteoporosis |
18 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.6865 |