National Provider Identifier [NPI]: |
1629027073 |
Last Name Of The Provider |
WREN |
First Name Of The Provider |
JENNIFER |
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 |
1502 TAUB LOOP |
Street Address 2 Of The Provider |
|
City Of The Provider |
HOUSTON |
Zip Code Of The Provider |
770301608 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Psychiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
8 |
Number Of Services |
142 |
Number Of Medicare Beneficiaries |
72 |
Total Submitted Charge Amount |
23651 |
Total Medicare Allowed Amount |
11694.93 |
Total Medicare Payment Amount |
8562.69 |
Total Medicare Standardized Payment Amount |
8476.84 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
47 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
336 |
Total Drug Medicare AllowedAmount |
100.94 |
Total Drug Medicare PaymentAmount |
76.74 |
Total Drug Medicare Standardized Payment Amount |
76.74 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
4 |
Number Of Medical Services |
95 |
Number Of Medicare Beneficiaries With Medical Services |
72 |
Total Medical Submitted Charge Amount |
23315 |
Total Medical Medicare Allowed Amount |
11593.99 |
Total Medical Medicare Payment Amount |
8485.95 |
Total Medical Medicare Standardized Payment Amount |
8400.1 |
Average Age Of Beneficiaries |
41 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
21 |
Number Of Male Beneficiaries |
51 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
40 |
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 |
22 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
50 |
Percent Of With Atrial Fibrillation |
0 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
21 |
Percent Of With Cancer |
0 |
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
75 |
Percent Of With Diabetes |
21 |
Percent Of With Hyperlipidemia |
|
Percent Of With Hypertension |
51 |
Percent Of With Ischemic Heart Disease |
21 |
Percent Of With Osteoporosis |
0 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
21 |
Percent Of With Schizophrenia Other PsychoticDisorders |
75 |
Percent Of With Stroke |
0 |
Average HCC Risk Score Of Beneficiaries |
1.2549 |