National Provider Identifier [NPI]: |
1295879518 |
Last Name Of The Provider |
JACOBY |
First Name Of The Provider |
WENDY |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
|
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
9 WASHINGTON AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
HAMDEN |
Zip Code Of The Provider |
065183267 |
State Code Of The Provider |
CT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Dermatology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
24 |
Number Of Services |
2018 |
Number Of Medicare Beneficiaries |
665 |
Total Submitted Charge Amount |
188575 |
Total Medicare Allowed Amount |
138279.18 |
Total Medicare Payment Amount |
99840.93 |
Total Medicare Standardized Payment Amount |
94349.82 |
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 |
24 |
Number Of Medical Services |
2018 |
Number Of Medicare Beneficiaries With Medical Services |
665 |
Total Medical Submitted Charge Amount |
188575 |
Total Medical Medicare Allowed Amount |
138279.18 |
Total Medical Medicare Payment Amount |
99840.93 |
Total Medical Medicare Standardized Payment Amount |
94349.82 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
32 |
Number Of Beneficiaries Age 65 to 74 |
338 |
Number Of Beneficiaries Age 75 to 84 |
197 |
Number Of Beneficiaries Age Greater 84 |
98 |
Number Of Female Beneficiaries |
468 |
Number Of Male Beneficiaries |
197 |
Number Of Non Hispanic White Beneficiaries |
609 |
Number Of Black or African American Beneficiaries |
18 |
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 |
20 |
Number Of Beneficiaries With Medicare Only Entitlement |
593 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
72 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
5 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
15 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
2 |
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
0.9559 |