National Provider Identifier [NPI]: |
1215265814 |
Last Name Of The Provider |
BRENNAN |
First Name Of The Provider |
CHRISTINA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1750 TREE BLVD |
Street Address 2 Of The Provider |
SUITE 1 |
City Of The Provider |
ST AUGUSTINE |
Zip Code Of The Provider |
320845715 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Dermatology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
65 |
Number Of Services |
4564 |
Number Of Medicare Beneficiaries |
750 |
Total Submitted Charge Amount |
492945.72 |
Total Medicare Allowed Amount |
258090.12 |
Total Medicare Payment Amount |
185646.92 |
Total Medicare Standardized Payment Amount |
186243.97 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
1 |
Number Of Drug Services |
25 |
Number Of Medicare Beneficiaries With Drug Services |
11 |
Total Drug Submitted ChargeAmount |
50 |
Total Drug Medicare AllowedAmount |
44.28 |
Total Drug Medicare PaymentAmount |
34.68 |
Total Drug Medicare Standardized Payment Amount |
34.68 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
64 |
Number Of Medical Services |
4539 |
Number Of Medicare Beneficiaries With Medical Services |
750 |
Total Medical Submitted Charge Amount |
492895.72 |
Total Medical Medicare Allowed Amount |
258045.84 |
Total Medical Medicare Payment Amount |
185612.24 |
Total Medical Medicare Standardized Payment Amount |
186209.29 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
31 |
Number Of Beneficiaries Age 65 to 74 |
455 |
Number Of Beneficiaries Age 75 to 84 |
185 |
Number Of Beneficiaries Age Greater 84 |
79 |
Number Of Female Beneficiaries |
508 |
Number Of Male Beneficiaries |
242 |
Number Of Non Hispanic White Beneficiaries |
722 |
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 |
12 |
Number Of Beneficiaries With Medicare Only Entitlement |
728 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
22 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
4 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
8 |
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
9 |
Percent Of With Depression |
13 |
Percent Of With Diabetes |
19 |
Percent Of With Hyperlipidemia |
65 |
Percent Of With Hypertension |
59 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
41 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
0.8006 |