National Provider Identifier [NPI]: |
1982917779 |
Last Name Of The Provider |
DREW |
First Name Of The Provider |
HEIDI |
Middle Initial Of The Provider |
N |
Credentials Of The Provider |
NP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
474 MAIN ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
SPRINGVALE |
Zip Code Of The Provider |
040831409 |
State Code Of The Provider |
ME |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
4 |
Number Of Services |
829 |
Number Of Medicare Beneficiaries |
130 |
Total Submitted Charge Amount |
94130.94 |
Total Medicare Allowed Amount |
66337.25 |
Total Medicare Payment Amount |
47417.05 |
Total Medicare Standardized Payment Amount |
58175.36 |
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 |
4 |
Number Of Medical Services |
829 |
Number Of Medicare Beneficiaries With Medical Services |
130 |
Total Medical Submitted Charge Amount |
94130.94 |
Total Medical Medicare Allowed Amount |
66337.25 |
Total Medical Medicare Payment Amount |
47417.05 |
Total Medical Medicare Standardized Payment Amount |
58175.36 |
Average Age Of Beneficiaries |
49 |
Number Of Beneficiaries Age Less65 |
114 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
85 |
Number Of Male Beneficiaries |
45 |
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 |
19 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
111 |
Percent Of With Atrial Fibrillation |
0 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
15 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
71 |
Percent Of With Diabetes |
18 |
Percent Of With Hyperlipidemia |
38 |
Percent Of With Hypertension |
32 |
Percent Of With Ischemic Heart Disease |
11 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
24 |
Percent Of With Stroke |
0 |
Average HCC Risk Score Of Beneficiaries |
1.1017 |