National Provider Identifier [NPI]: |
1942292396 |
Last Name Of The Provider |
AMBORD |
First Name Of The Provider |
JEFFREY |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
5200 HUMMINGBIRD RD |
Street Address 2 Of The Provider |
STE 100 |
City Of The Provider |
WAUSAU |
Zip Code Of The Provider |
544016312 |
State Code Of The Provider |
WI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
62 |
Number Of Services |
724 |
Number Of Medicare Beneficiaries |
204 |
Total Submitted Charge Amount |
604607.4 |
Total Medicare Allowed Amount |
39017.92 |
Total Medicare Payment Amount |
29091.25 |
Total Medicare Standardized Payment Amount |
33239.17 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
187 |
Number Of Medicare Beneficiaries With Drug Services |
71 |
Total Drug Submitted ChargeAmount |
13556.4 |
Total Drug Medicare AllowedAmount |
5155.46 |
Total Drug Medicare PaymentAmount |
4021.65 |
Total Drug Medicare Standardized Payment Amount |
4021.65 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
59 |
Number Of Medical Services |
537 |
Number Of Medicare Beneficiaries With Medical Services |
204 |
Total Medical Submitted Charge Amount |
591051 |
Total Medical Medicare Allowed Amount |
33862.46 |
Total Medical Medicare Payment Amount |
25069.6 |
Total Medical Medicare Standardized Payment Amount |
29217.52 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
46 |
Number Of Beneficiaries Age 65 to 74 |
77 |
Number Of Beneficiaries Age 75 to 84 |
58 |
Number Of Beneficiaries Age Greater 84 |
23 |
Number Of Female Beneficiaries |
117 |
Number Of Male Beneficiaries |
87 |
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 |
145 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
59 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
17 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
64 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.067 |