National Provider Identifier [NPI]: |
1619017167 |
Last Name Of The Provider |
MILLMUN |
First Name Of The Provider |
JENNIFER |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
PA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
44201 DEQUINDRE RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
TROY |
Zip Code Of The Provider |
480851117 |
State Code Of The Provider |
MI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
5 |
Number Of Services |
164 |
Number Of Medicare Beneficiaries |
161 |
Total Submitted Charge Amount |
22195 |
Total Medicare Allowed Amount |
14073.35 |
Total Medicare Payment Amount |
11033.72 |
Total Medicare Standardized Payment Amount |
12536.76 |
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 |
5 |
Number Of Medical Services |
164 |
Number Of Medicare Beneficiaries With Medical Services |
161 |
Total Medical Submitted Charge Amount |
22195 |
Total Medical Medicare Allowed Amount |
14073.35 |
Total Medical Medicare Payment Amount |
11033.72 |
Total Medical Medicare Standardized Payment Amount |
12536.76 |
Average Age Of Beneficiaries |
77 |
Number Of Beneficiaries Age Less65 |
17 |
Number Of Beneficiaries Age 65 to 74 |
56 |
Number Of Beneficiaries Age 75 to 84 |
43 |
Number Of Beneficiaries Age Greater 84 |
45 |
Number Of Female Beneficiaries |
100 |
Number Of Male Beneficiaries |
61 |
Number Of Non Hispanic White Beneficiaries |
148 |
Number Of Black or African American Beneficiaries |
|
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 |
120 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
41 |
Percent Of With Atrial Fibrillation |
31 |
Percent Of With Alzheimers Disease or Dementia |
32 |
Percent Of With Asthma |
20 |
Percent Of With Cancer |
24 |
Percent Of With Heart Failure |
55 |
Percent Of With Chronic Kidney Disease |
61 |
Percent Of With Chronic Obstructive Pulmonary Disease |
46 |
Percent Of With Depression |
39 |
Percent Of With Diabetes |
52 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
74 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
16 |
Percent Of With Stroke |
17 |
Average HCC Risk Score Of Beneficiaries |
2.5807 |