National Provider Identifier [NPI]: |
1831205392 |
Last Name Of The Provider |
HAZELTON |
First Name Of The Provider |
LISA |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
115 8TH ST NE |
Street Address 2 Of The Provider |
|
City Of The Provider |
CEDAR RAPIDS |
Zip Code Of The Provider |
524011013 |
State Code Of The Provider |
IA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
61 |
Number Of Services |
4727 |
Number Of Medicare Beneficiaries |
477 |
Total Submitted Charge Amount |
449731 |
Total Medicare Allowed Amount |
208824.9 |
Total Medicare Payment Amount |
162438.29 |
Total Medicare Standardized Payment Amount |
173597.49 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
228 |
Number Of Medicare Beneficiaries With Drug Services |
180 |
Total Drug Submitted ChargeAmount |
9506 |
Total Drug Medicare AllowedAmount |
7077.36 |
Total Drug Medicare PaymentAmount |
6904.04 |
Total Drug Medicare Standardized Payment Amount |
6904.04 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
56 |
Number Of Medical Services |
4499 |
Number Of Medicare Beneficiaries With Medical Services |
477 |
Total Medical Submitted Charge Amount |
440225 |
Total Medical Medicare Allowed Amount |
201747.54 |
Total Medical Medicare Payment Amount |
155534.25 |
Total Medical Medicare Standardized Payment Amount |
166693.45 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
31 |
Number Of Beneficiaries Age 65 to 74 |
192 |
Number Of Beneficiaries Age 75 to 84 |
167 |
Number Of Beneficiaries Age Greater 84 |
87 |
Number Of Female Beneficiaries |
336 |
Number Of Male Beneficiaries |
141 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
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 |
444 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
33 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
66 |
Percent Of With Hypertension |
74 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
2 |
Average HCC Risk Score Of Beneficiaries |
1.0878 |