National Provider Identifier [NPI]: |
1275548018 |
Last Name Of The Provider |
BERGQUIST |
First Name Of The Provider |
SHARON |
Middle Initial Of The Provider |
H |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2801 N DECATUR RD |
Street Address 2 Of The Provider |
SUITE 295 |
City Of The Provider |
DECATUR |
Zip Code Of The Provider |
300335949 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
35 |
Number Of Services |
797 |
Number Of Medicare Beneficiaries |
212 |
Total Submitted Charge Amount |
157921 |
Total Medicare Allowed Amount |
54173.42 |
Total Medicare Payment Amount |
38748.56 |
Total Medicare Standardized Payment Amount |
38844.07 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
90 |
Number Of Medicare Beneficiaries With Drug Services |
68 |
Total Drug Submitted ChargeAmount |
18211 |
Total Drug Medicare AllowedAmount |
3997.35 |
Total Drug Medicare PaymentAmount |
3908.34 |
Total Drug Medicare Standardized Payment Amount |
3908.34 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
27 |
Number Of Medical Services |
707 |
Number Of Medicare Beneficiaries With Medical Services |
212 |
Total Medical Submitted Charge Amount |
139710 |
Total Medical Medicare Allowed Amount |
50176.07 |
Total Medical Medicare Payment Amount |
34840.22 |
Total Medical Medicare Standardized Payment Amount |
34935.73 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
117 |
Number Of Beneficiaries Age 75 to 84 |
60 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
175 |
Number Of Male Beneficiaries |
37 |
Number Of Non Hispanic White Beneficiaries |
182 |
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 |
|
Percent Of With Asthma |
5 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
8 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
13 |
Percent Of With Diabetes |
13 |
Percent Of With Hyperlipidemia |
45 |
Percent Of With Hypertension |
51 |
Percent Of With Ischemic Heart Disease |
17 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
23 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7404 |