National Provider Identifier [NPI]: |
1407177595 |
Last Name Of The Provider |
TAYLOR |
First Name Of The Provider |
WINNA |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
430 E DIVISION ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
FOND DU LAC |
Zip Code Of The Provider |
549354560 |
State Code Of The Provider |
WI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
20 |
Number Of Services |
712 |
Number Of Medicare Beneficiaries |
276 |
Total Submitted Charge Amount |
231701 |
Total Medicare Allowed Amount |
69018.1 |
Total Medicare Payment Amount |
53098.52 |
Total Medicare Standardized Payment Amount |
55724.31 |
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 |
20 |
Number Of Medical Services |
712 |
Number Of Medicare Beneficiaries With Medical Services |
276 |
Total Medical Submitted Charge Amount |
231701 |
Total Medical Medicare Allowed Amount |
69018.1 |
Total Medical Medicare Payment Amount |
53098.52 |
Total Medical Medicare Standardized Payment Amount |
55724.31 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
53 |
Number Of Beneficiaries Age 65 to 74 |
57 |
Number Of Beneficiaries Age 75 to 84 |
83 |
Number Of Beneficiaries Age Greater 84 |
83 |
Number Of Female Beneficiaries |
166 |
Number Of Male Beneficiaries |
110 |
Number Of Non Hispanic White Beneficiaries |
258 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
186 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
90 |
Percent Of With Atrial Fibrillation |
27 |
Percent Of With Alzheimers Disease or Dementia |
17 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
18 |
Percent Of With Heart Failure |
52 |
Percent Of With Chronic Kidney Disease |
56 |
Percent Of With Chronic Obstructive Pulmonary Disease |
36 |
Percent Of With Depression |
34 |
Percent Of With Diabetes |
47 |
Percent Of With Hyperlipidemia |
71 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
51 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
12 |
Percent Of With Stroke |
15 |
Average HCC Risk Score Of Beneficiaries |
2.3278 |