National Provider Identifier [NPI]: |
1386733863 |
Last Name Of The Provider |
WALLIS |
First Name Of The Provider |
DENISE |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
9715 LIBERIA AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
MANASSAS |
Zip Code Of The Provider |
201105837 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
56 |
Number Of Services |
635 |
Number Of Medicare Beneficiaries |
231 |
Total Submitted Charge Amount |
61786.5 |
Total Medicare Allowed Amount |
26923.53 |
Total Medicare Payment Amount |
18101.82 |
Total Medicare Standardized Payment Amount |
18838.75 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
12 |
Number Of Medicare Beneficiaries With Drug Services |
12 |
Total Drug Submitted ChargeAmount |
232 |
Total Drug Medicare AllowedAmount |
99.72 |
Total Drug Medicare PaymentAmount |
88.63 |
Total Drug Medicare Standardized Payment Amount |
88.63 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
53 |
Number Of Medical Services |
623 |
Number Of Medicare Beneficiaries With Medical Services |
231 |
Total Medical Submitted Charge Amount |
61554.5 |
Total Medical Medicare Allowed Amount |
26823.81 |
Total Medical Medicare Payment Amount |
18013.19 |
Total Medical Medicare Standardized Payment Amount |
18750.12 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
24 |
Number Of Beneficiaries Age 65 to 74 |
130 |
Number Of Beneficiaries Age 75 to 84 |
60 |
Number Of Beneficiaries Age Greater 84 |
17 |
Number Of Female Beneficiaries |
153 |
Number Of Male Beneficiaries |
78 |
Number Of Non Hispanic White Beneficiaries |
164 |
Number Of Black or African American Beneficiaries |
27 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
20 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
209 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
22 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
13 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
13 |
Percent Of With Diabetes |
25 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
61 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
33 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9535 |