National Provider Identifier [NPI]: |
1619911070 |
Last Name Of The Provider |
WIDDOWS |
First Name Of The Provider |
JOANNA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
DO |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
13660 JOG RD |
Street Address 2 Of The Provider |
SUITE B5 |
City Of The Provider |
DELRAY BEACH |
Zip Code Of The Provider |
334463806 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
57 |
Number Of Services |
4234 |
Number Of Medicare Beneficiaries |
551 |
Total Submitted Charge Amount |
430804.31 |
Total Medicare Allowed Amount |
296413.25 |
Total Medicare Payment Amount |
221032.5 |
Total Medicare Standardized Payment Amount |
211176.77 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
125 |
Number Of Medicare Beneficiaries With Drug Services |
107 |
Total Drug Submitted ChargeAmount |
3725 |
Total Drug Medicare AllowedAmount |
2355.72 |
Total Drug Medicare PaymentAmount |
2293.24 |
Total Drug Medicare Standardized Payment Amount |
2293.24 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
50 |
Number Of Medical Services |
4109 |
Number Of Medicare Beneficiaries With Medical Services |
551 |
Total Medical Submitted Charge Amount |
427079.31 |
Total Medical Medicare Allowed Amount |
294057.53 |
Total Medical Medicare Payment Amount |
218739.26 |
Total Medical Medicare Standardized Payment Amount |
208883.53 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
22 |
Number Of Beneficiaries Age 65 to 74 |
330 |
Number Of Beneficiaries Age 75 to 84 |
157 |
Number Of Beneficiaries Age Greater 84 |
42 |
Number Of Female Beneficiaries |
395 |
Number Of Male Beneficiaries |
156 |
Number Of Non Hispanic White Beneficiaries |
522 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
13 |
Number Of Beneficiaries With Medicare Only Entitlement |
533 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
18 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
7 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
12 |
Percent Of With Diabetes |
20 |
Percent Of With Hyperlipidemia |
74 |
Percent Of With Hypertension |
67 |
Percent Of With Ischemic Heart Disease |
28 |
Percent Of With Osteoporosis |
18 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
39 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
0.9175 |