National Provider Identifier [NPI]: |
1467516005 |
Last Name Of The Provider |
SHANNAHAN |
First Name Of The Provider |
JILL |
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 |
1400 EMELINE AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
SANTA CRUZ |
Zip Code Of The Provider |
950601976 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Psychiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
18 |
Number Of Services |
2431 |
Number Of Medicare Beneficiaries |
374 |
Total Submitted Charge Amount |
491986.38 |
Total Medicare Allowed Amount |
183664.37 |
Total Medicare Payment Amount |
134515.56 |
Total Medicare Standardized Payment Amount |
130564.4 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
18 |
Number Of Medical Services |
2431 |
Number Of Medicare Beneficiaries With Medical Services |
374 |
Total Medical Submitted Charge Amount |
491986.38 |
Total Medical Medicare Allowed Amount |
183664.37 |
Total Medical Medicare Payment Amount |
134515.56 |
Total Medical Medicare Standardized Payment Amount |
130564.4 |
Average Age Of Beneficiaries |
54 |
Number Of Beneficiaries Age Less65 |
282 |
Number Of Beneficiaries Age 65 to 74 |
53 |
Number Of Beneficiaries Age 75 to 84 |
27 |
Number Of Beneficiaries Age Greater 84 |
12 |
Number Of Female Beneficiaries |
195 |
Number Of Male Beneficiaries |
179 |
Number Of Non Hispanic White Beneficiaries |
298 |
Number Of Black or African American Beneficiaries |
14 |
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 |
76 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
298 |
Percent Of With Atrial Fibrillation |
4 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
6 |
Percent Of With Heart Failure |
7 |
Percent Of With Chronic Kidney Disease |
12 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
50 |
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
29 |
Percent Of With Hypertension |
33 |
Percent Of With Ischemic Heart Disease |
11 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
23 |
Percent Of With Schizophrenia Other PsychoticDisorders |
58 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1478 |