National Provider Identifier [NPI]: |
1528311776 |
Last Name Of The Provider |
MONROY |
First Name Of The Provider |
JUAN |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
RN |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
125 KILLIAN AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
TRUMBULL |
Zip Code Of The Provider |
066114119 |
State Code Of The Provider |
CT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
51 |
Number Of Services |
166 |
Number Of Medicare Beneficiaries |
165 |
Total Submitted Charge Amount |
342248 |
Total Medicare Allowed Amount |
25557.71 |
Total Medicare Payment Amount |
20048.58 |
Total Medicare Standardized Payment Amount |
18994 |
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 |
51 |
Number Of Medical Services |
166 |
Number Of Medicare Beneficiaries With Medical Services |
165 |
Total Medical Submitted Charge Amount |
342248 |
Total Medical Medicare Allowed Amount |
25557.71 |
Total Medical Medicare Payment Amount |
20048.58 |
Total Medical Medicare Standardized Payment Amount |
18994 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
41 |
Number Of Beneficiaries Age 65 to 74 |
59 |
Number Of Beneficiaries Age 75 to 84 |
42 |
Number Of Beneficiaries Age Greater 84 |
23 |
Number Of Female Beneficiaries |
91 |
Number Of Male Beneficiaries |
74 |
Number Of Non Hispanic White Beneficiaries |
129 |
Number Of Black or African American Beneficiaries |
18 |
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 |
94 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
71 |
Percent Of With Atrial Fibrillation |
22 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
19 |
Percent Of With Heart Failure |
35 |
Percent Of With Chronic Kidney Disease |
44 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
30 |
Percent Of With Diabetes |
43 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
42 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
2.4435 |