National Provider Identifier [NPI]: |
1306035910 |
Last Name Of The Provider |
REA |
First Name Of The Provider |
MISTY |
Middle Initial Of The Provider |
N |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1314 19TH AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
MERIDIAN |
Zip Code Of The Provider |
393014116 |
State Code Of The Provider |
MS |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
28 |
Number Of Services |
571 |
Number Of Medicare Beneficiaries |
451 |
Total Submitted Charge Amount |
217547 |
Total Medicare Allowed Amount |
63243.98 |
Total Medicare Payment Amount |
48215.77 |
Total Medicare Standardized Payment Amount |
50449.72 |
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 |
28 |
Number Of Medical Services |
571 |
Number Of Medicare Beneficiaries With Medical Services |
451 |
Total Medical Submitted Charge Amount |
217547 |
Total Medical Medicare Allowed Amount |
63243.98 |
Total Medical Medicare Payment Amount |
48215.77 |
Total Medical Medicare Standardized Payment Amount |
50449.72 |
Average Age Of Beneficiaries |
65 |
Number Of Beneficiaries Age Less65 |
175 |
Number Of Beneficiaries Age 65 to 74 |
143 |
Number Of Beneficiaries Age 75 to 84 |
93 |
Number Of Beneficiaries Age Greater 84 |
40 |
Number Of Female Beneficiaries |
252 |
Number Of Male Beneficiaries |
199 |
Number Of Non Hispanic White Beneficiaries |
297 |
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 |
217 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
234 |
Percent Of With Atrial Fibrillation |
15 |
Percent Of With Alzheimers Disease or Dementia |
19 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
6 |
Percent Of With Heart Failure |
35 |
Percent Of With Chronic Kidney Disease |
31 |
Percent Of With Chronic Obstructive Pulmonary Disease |
32 |
Percent Of With Depression |
40 |
Percent Of With Diabetes |
45 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
49 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
58 |
Percent Of With Schizophrenia Other PsychoticDisorders |
15 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
1.7575 |