National Provider Identifier [NPI]: |
1154603454 |
Last Name Of The Provider |
SMITH |
First Name Of The Provider |
MARCIA |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
PH.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
69 JOHN ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
PROVIDENCE |
Zip Code Of The Provider |
029062033 |
State Code Of The Provider |
RI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Clinical Psychologist |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
6 |
Number Of Services |
138 |
Number Of Medicare Beneficiaries |
15 |
Total Submitted Charge Amount |
25060 |
Total Medicare Allowed Amount |
15955.08 |
Total Medicare Payment Amount |
12427.64 |
Total Medicare Standardized Payment Amount |
12146.62 |
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 |
6 |
Number Of Medical Services |
138 |
Number Of Medicare Beneficiaries With Medical Services |
15 |
Total Medical Submitted Charge Amount |
25060 |
Total Medical Medicare Allowed Amount |
15955.08 |
Total Medical Medicare Payment Amount |
12427.64 |
Total Medical Medicare Standardized Payment Amount |
12146.62 |
Average Age Of Beneficiaries |
65 |
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 |
|
Number Of Male Beneficiaries |
|
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
0 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
0 |
Percent Of With Depression |
|
Percent Of With Diabetes |
|
Percent Of With Hyperlipidemia |
|
Percent Of With Hypertension |
|
Percent Of With Ischemic Heart Disease |
|
Percent Of With Osteoporosis |
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Percent Of With Rheumatoid Arthritis Osteoarthritis |
|
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
0 |
Average HCC Risk Score Of Beneficiaries |
1.2284 |