National Provider Identifier [NPI]: |
1366411340 |
Last Name Of The Provider |
AMBROSE |
First Name Of The Provider |
LINDA |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
CNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
444 N CLEVELAND AVE |
Street Address 2 Of The Provider |
SUITE 200 |
City Of The Provider |
WESTERVILLE |
Zip Code Of The Provider |
430828387 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
21 |
Number Of Services |
318 |
Number Of Medicare Beneficiaries |
164 |
Total Submitted Charge Amount |
28608 |
Total Medicare Allowed Amount |
17178.35 |
Total Medicare Payment Amount |
10647.66 |
Total Medicare Standardized Payment Amount |
13873.98 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
16 |
Number Of Medicare Beneficiaries With Drug Services |
12 |
Total Drug Submitted ChargeAmount |
650 |
Total Drug Medicare AllowedAmount |
346.33 |
Total Drug Medicare PaymentAmount |
332.48 |
Total Drug Medicare Standardized Payment Amount |
332.48 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
15 |
Number Of Medical Services |
302 |
Number Of Medicare Beneficiaries With Medical Services |
164 |
Total Medical Submitted Charge Amount |
27958 |
Total Medical Medicare Allowed Amount |
16832.02 |
Total Medical Medicare Payment Amount |
10315.18 |
Total Medical Medicare Standardized Payment Amount |
13541.5 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
38 |
Number Of Beneficiaries Age 65 to 74 |
87 |
Number Of Beneficiaries Age 75 to 84 |
23 |
Number Of Beneficiaries Age Greater 84 |
16 |
Number Of Female Beneficiaries |
93 |
Number Of Male Beneficiaries |
71 |
Number Of Non Hispanic White Beneficiaries |
140 |
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 |
141 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
23 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
10 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
35 |
Percent Of With Hypertension |
52 |
Percent Of With Ischemic Heart Disease |
23 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9592 |