National Provider Identifier [NPI]: |
1952697096 |
Last Name Of The Provider |
EVERETT |
First Name Of The Provider |
VANESSA |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
19485 OLD JETTON RD |
Street Address 2 Of The Provider |
SUITE 100 |
City Of The Provider |
CORNELIUS |
Zip Code Of The Provider |
280316582 |
State Code Of The Provider |
NC |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
36 |
Number Of Services |
136 |
Number Of Medicare Beneficiaries |
55 |
Total Submitted Charge Amount |
18847 |
Total Medicare Allowed Amount |
8874.42 |
Total Medicare Payment Amount |
6969.54 |
Total Medicare Standardized Payment Amount |
7253.9 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
23 |
Number Of Medicare Beneficiaries With Drug Services |
12 |
Total Drug Submitted ChargeAmount |
637 |
Total Drug Medicare AllowedAmount |
256.5 |
Total Drug Medicare PaymentAmount |
247.77 |
Total Drug Medicare Standardized Payment Amount |
247.77 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
28 |
Number Of Medical Services |
113 |
Number Of Medicare Beneficiaries With Medical Services |
55 |
Total Medical Submitted Charge Amount |
18210 |
Total Medical Medicare Allowed Amount |
8617.92 |
Total Medical Medicare Payment Amount |
6721.77 |
Total Medical Medicare Standardized Payment Amount |
7006.13 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
33 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
34 |
Number Of Male Beneficiaries |
21 |
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 |
|
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 |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
45 |
Percent Of With Hypertension |
44 |
Percent Of With Ischemic Heart Disease |
22 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
24 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7376 |