National Provider Identifier [NPI]: |
1932176922 |
Last Name Of The Provider |
WESSELL |
First Name Of The Provider |
JUDY |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
FNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
825 FAIRFAX AVE |
Street Address 2 Of The Provider |
SUITE 545 |
City Of The Provider |
NORFOLK |
Zip Code Of The Provider |
235071914 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
148 |
Number Of Medicare Beneficiaries |
49 |
Total Submitted Charge Amount |
14700 |
Total Medicare Allowed Amount |
8004.49 |
Total Medicare Payment Amount |
4999.09 |
Total Medicare Standardized Payment Amount |
6014.53 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
25 |
Number Of Medicare Beneficiaries With Drug Services |
17 |
Total Drug Submitted ChargeAmount |
2185 |
Total Drug Medicare AllowedAmount |
1283.83 |
Total Drug Medicare PaymentAmount |
1258.15 |
Total Drug Medicare Standardized Payment Amount |
1258.15 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
10 |
Number Of Medical Services |
123 |
Number Of Medicare Beneficiaries With Medical Services |
49 |
Total Medical Submitted Charge Amount |
12515 |
Total Medical Medicare Allowed Amount |
6720.66 |
Total Medical Medicare Payment Amount |
3740.94 |
Total Medical Medicare Standardized Payment Amount |
4756.38 |
Average Age Of Beneficiaries |
55 |
Number Of Beneficiaries Age Less65 |
38 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
0 |
Number Of Female Beneficiaries |
23 |
Number Of Male Beneficiaries |
26 |
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 |
23 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
26 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
|
Percent Of With Hyperlipidemia |
39 |
Percent Of With Hypertension |
55 |
Percent Of With Ischemic Heart Disease |
|
Percent Of With Osteoporosis |
0 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
27 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2824 |