National Provider Identifier [NPI]: |
1619963345 |
Last Name Of The Provider |
IANNONE |
First Name Of The Provider |
GLORIA |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
CRNA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1364 CLIFTON RD NE |
Street Address 2 Of The Provider |
STE B3 |
City Of The Provider |
ATLANTA |
Zip Code Of The Provider |
303221059 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
12 |
Number Of Services |
170 |
Number Of Medicare Beneficiaries |
165 |
Total Submitted Charge Amount |
164736 |
Total Medicare Allowed Amount |
14995.11 |
Total Medicare Payment Amount |
11597.08 |
Total Medicare Standardized Payment Amount |
11700.51 |
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 |
12 |
Number Of Medical Services |
170 |
Number Of Medicare Beneficiaries With Medical Services |
165 |
Total Medical Submitted Charge Amount |
164736 |
Total Medical Medicare Allowed Amount |
14995.11 |
Total Medical Medicare Payment Amount |
11597.08 |
Total Medical Medicare Standardized Payment Amount |
11700.51 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
36 |
Number Of Beneficiaries Age 65 to 74 |
81 |
Number Of Beneficiaries Age 75 to 84 |
36 |
Number Of Beneficiaries Age Greater 84 |
12 |
Number Of Female Beneficiaries |
103 |
Number Of Male Beneficiaries |
62 |
Number Of Non Hispanic White Beneficiaries |
88 |
Number Of Black or African American Beneficiaries |
65 |
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 |
129 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
36 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
27 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
45 |
Percent Of With Hypertension |
59 |
Percent Of With Ischemic Heart Disease |
28 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.4196 |