National Provider Identifier [NPI]: |
1699745166 |
Last Name Of The Provider |
SPEAKER |
First Name Of The Provider |
JENNIFER |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2400 MALL CIR |
Street Address 2 Of The Provider |
|
City Of The Provider |
FORT WORTH |
Zip Code Of The Provider |
761161544 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
64 |
Number Of Services |
1892 |
Number Of Medicare Beneficiaries |
453 |
Total Submitted Charge Amount |
191926 |
Total Medicare Allowed Amount |
91741.13 |
Total Medicare Payment Amount |
60119.4 |
Total Medicare Standardized Payment Amount |
63544.53 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
14 |
Number Of Drug Services |
221 |
Number Of Medicare Beneficiaries With Drug Services |
98 |
Total Drug Submitted ChargeAmount |
10242 |
Total Drug Medicare AllowedAmount |
3213.09 |
Total Drug Medicare PaymentAmount |
2744.29 |
Total Drug Medicare Standardized Payment Amount |
2744.29 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
50 |
Number Of Medical Services |
1671 |
Number Of Medicare Beneficiaries With Medical Services |
453 |
Total Medical Submitted Charge Amount |
181684 |
Total Medical Medicare Allowed Amount |
88528.04 |
Total Medical Medicare Payment Amount |
57375.11 |
Total Medical Medicare Standardized Payment Amount |
60800.24 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
80 |
Number Of Beneficiaries Age 65 to 74 |
210 |
Number Of Beneficiaries Age 75 to 84 |
120 |
Number Of Beneficiaries Age Greater 84 |
43 |
Number Of Female Beneficiaries |
332 |
Number Of Male Beneficiaries |
121 |
Number Of Non Hispanic White Beneficiaries |
307 |
Number Of Black or African American Beneficiaries |
91 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
40 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
371 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
82 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
53 |
Percent Of With Hypertension |
66 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.177 |