National Provider Identifier [NPI]: |
1053578757 |
Last Name Of The Provider |
VENT |
First Name Of The Provider |
CHEVONE |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
885 N SANDUSKY AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
UPPER SANDUSKY |
Zip Code Of The Provider |
433511031 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
18 |
Number Of Services |
114 |
Number Of Medicare Beneficiaries |
64 |
Total Submitted Charge Amount |
14829.89 |
Total Medicare Allowed Amount |
6888.04 |
Total Medicare Payment Amount |
4995.71 |
Total Medicare Standardized Payment Amount |
5122.55 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
18 |
Number Of Medicare Beneficiaries With Drug Services |
17 |
Total Drug Submitted ChargeAmount |
2240.24 |
Total Drug Medicare AllowedAmount |
955.4 |
Total Drug Medicare PaymentAmount |
936.25 |
Total Drug Medicare Standardized Payment Amount |
936.25 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
15 |
Number Of Medical Services |
96 |
Number Of Medicare Beneficiaries With Medical Services |
63 |
Total Medical Submitted Charge Amount |
12589.65 |
Total Medical Medicare Allowed Amount |
5932.64 |
Total Medical Medicare Payment Amount |
4059.46 |
Total Medical Medicare Standardized Payment Amount |
4186.3 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
22 |
Number Of Beneficiaries Age 75 to 84 |
20 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
34 |
Number Of Male Beneficiaries |
30 |
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 |
45 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
19 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
30 |
Percent Of With Chronic Kidney Disease |
27 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
|
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
64 |
Percent Of With Hypertension |
73 |
Percent Of With Ischemic Heart Disease |
31 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
0 |
Average HCC Risk Score Of Beneficiaries |
1.2383 |