National Provider Identifier [NPI]: |
1558466219 |
Last Name Of The Provider |
GROS |
First Name Of The Provider |
JENNIFER |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
PA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
333 N PRAIRIE AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
INGLEWOOD |
Zip Code Of The Provider |
903014501 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
24 |
Number Of Services |
186 |
Number Of Medicare Beneficiaries |
144 |
Total Submitted Charge Amount |
73748 |
Total Medicare Allowed Amount |
13818.12 |
Total Medicare Payment Amount |
10191.57 |
Total Medicare Standardized Payment Amount |
11588.71 |
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 |
24 |
Number Of Medical Services |
186 |
Number Of Medicare Beneficiaries With Medical Services |
144 |
Total Medical Submitted Charge Amount |
73748 |
Total Medical Medicare Allowed Amount |
13818.12 |
Total Medical Medicare Payment Amount |
10191.57 |
Total Medical Medicare Standardized Payment Amount |
11588.71 |
Average Age Of Beneficiaries |
63 |
Number Of Beneficiaries Age Less65 |
66 |
Number Of Beneficiaries Age 65 to 74 |
48 |
Number Of Beneficiaries Age 75 to 84 |
16 |
Number Of Beneficiaries Age Greater 84 |
14 |
Number Of Female Beneficiaries |
77 |
Number Of Male Beneficiaries |
67 |
Number Of Non Hispanic White Beneficiaries |
82 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
14 |
Number Of Hispanic Beneficiaries |
33 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
46 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
98 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
17 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
29 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
42 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
47 |
Percent Of With Hypertension |
57 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
48 |
Percent Of With Schizophrenia Other PsychoticDisorders |
19 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.6144 |