National Provider Identifier [NPI]: |
1881680353 |
Last Name Of The Provider |
NELLSCH |
First Name Of The Provider |
VERNER |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1717 HIGHWAY 59 LOOP N |
Street Address 2 Of The Provider |
SUITE C |
City Of The Provider |
LIVINGSTON |
Zip Code Of The Provider |
773515703 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Obstetrics/Gynecology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
30 |
Number Of Services |
654 |
Number Of Medicare Beneficiaries |
80 |
Total Submitted Charge Amount |
43055 |
Total Medicare Allowed Amount |
17633.21 |
Total Medicare Payment Amount |
13865.75 |
Total Medicare Standardized Payment Amount |
15376.3 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
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Number Of Drug Services |
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Number Of Medicare Beneficiaries With Drug Services |
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Total Drug Submitted ChargeAmount |
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Total Drug Medicare AllowedAmount |
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Total Drug Medicare PaymentAmount |
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Total Drug Medicare Standardized Payment Amount |
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Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
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Number Of Medical Services |
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Number Of Medicare Beneficiaries With Medical Services |
|
Total Medical Submitted Charge Amount |
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Total Medical Medicare Allowed Amount |
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Total Medical Medicare Payment Amount |
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Total Medical Medicare Standardized Payment Amount |
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Average Age Of Beneficiaries |
58 |
Number Of Beneficiaries Age Less65 |
43 |
Number Of Beneficiaries Age 65 to 74 |
24 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
80 |
Number Of Male Beneficiaries |
0 |
Number Of Non Hispanic White Beneficiaries |
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Number Of Black or African American Beneficiaries |
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Number Of AsianPacific Islander Beneficiaries |
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Number Of Hispanic Beneficiaries |
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Number Of American Indian Alaska Native Beneficiaries |
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Number Of Beneficiaries With Race Not Else where Classified |
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Number Of Beneficiaries With Medicare Only Entitlement |
43 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
37 |
Percent Of With Atrial Fibrillation |
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Percent Of With Alzheimers Disease or Dementia |
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Percent Of With Asthma |
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Percent Of With Cancer |
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Percent Of With Heart Failure |
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Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
38 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
61 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
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Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
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Percent Of With Stroke |
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Average HCC Risk Score Of Beneficiaries |
1.0653 |