National Provider Identifier [NPI]: |
1992909238 |
Last Name Of The Provider |
BETTENCOURT |
First Name Of The Provider |
GAIL |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
CRNA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
326 WASHINGTON STREET |
Street Address 2 Of The Provider |
|
City Of The Provider |
NORWICH |
Zip Code Of The Provider |
06360 |
State Code Of The Provider |
CT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
25 |
Number Of Services |
48 |
Number Of Medicare Beneficiaries |
48 |
Total Submitted Charge Amount |
79825.78 |
Total Medicare Allowed Amount |
8009.51 |
Total Medicare Payment Amount |
6279.41 |
Total Medicare Standardized Payment Amount |
5950.41 |
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 |
25 |
Number Of Medical Services |
48 |
Number Of Medicare Beneficiaries With Medical Services |
48 |
Total Medical Submitted Charge Amount |
79825.78 |
Total Medical Medicare Allowed Amount |
8009.51 |
Total Medical Medicare Payment Amount |
6279.41 |
Total Medical Medicare Standardized Payment Amount |
5950.41 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
12 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
17 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
30 |
Number Of Male Beneficiaries |
18 |
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 |
25 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
23 |
Percent Of With Atrial Fibrillation |
25 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
40 |
Percent Of With Chronic Kidney Disease |
60 |
Percent Of With Chronic Obstructive Pulmonary Disease |
38 |
Percent Of With Depression |
48 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
65 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
58 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
2.1678 |