National Provider Identifier [NPI]: |
1679842603 |
Last Name Of The Provider |
AGURA |
First Name Of The Provider |
KRISTEN |
Middle Initial Of The Provider |
X |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3500 GASTON AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
DALLAS |
Zip Code Of The Provider |
752462017 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
19 |
Number Of Services |
195 |
Number Of Medicare Beneficiaries |
167 |
Total Submitted Charge Amount |
196713 |
Total Medicare Allowed Amount |
20608.8 |
Total Medicare Payment Amount |
15198.31 |
Total Medicare Standardized Payment Amount |
18052.78 |
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 |
19 |
Number Of Medical Services |
195 |
Number Of Medicare Beneficiaries With Medical Services |
167 |
Total Medical Submitted Charge Amount |
196713 |
Total Medical Medicare Allowed Amount |
20608.8 |
Total Medical Medicare Payment Amount |
15198.31 |
Total Medical Medicare Standardized Payment Amount |
18052.78 |
Average Age Of Beneficiaries |
63 |
Number Of Beneficiaries Age Less65 |
84 |
Number Of Beneficiaries Age 65 to 74 |
37 |
Number Of Beneficiaries Age 75 to 84 |
34 |
Number Of Beneficiaries Age Greater 84 |
12 |
Number Of Female Beneficiaries |
108 |
Number Of Male Beneficiaries |
59 |
Number Of Non Hispanic White Beneficiaries |
58 |
Number Of Black or African American Beneficiaries |
87 |
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 |
63 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
104 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
21 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
37 |
Percent Of With Chronic Kidney Disease |
36 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
45 |
Percent Of With Diabetes |
51 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
57 |
Percent Of With Schizophrenia Other PsychoticDisorders |
13 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
2.2283 |