National Provider Identifier [NPI]: |
1265543847 |
Last Name Of The Provider |
MCDOUGALL |
First Name Of The Provider |
LINDA |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
NP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
900 BROADWAY |
Street Address 2 Of The Provider |
|
City Of The Provider |
BANGOR |
Zip Code Of The Provider |
044011900 |
State Code Of The Provider |
ME |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
289 |
Number Of Medicare Beneficiaries |
122 |
Total Submitted Charge Amount |
32290 |
Total Medicare Allowed Amount |
17075.14 |
Total Medicare Payment Amount |
11363.87 |
Total Medicare Standardized Payment Amount |
14821.04 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
24 |
Number Of Medicare Beneficiaries With Drug Services |
22 |
Total Drug Submitted ChargeAmount |
150 |
Total Drug Medicare AllowedAmount |
91.08 |
Total Drug Medicare PaymentAmount |
73.88 |
Total Drug Medicare Standardized Payment Amount |
73.88 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
13 |
Number Of Medical Services |
265 |
Number Of Medicare Beneficiaries With Medical Services |
122 |
Total Medical Submitted Charge Amount |
32140 |
Total Medical Medicare Allowed Amount |
16984.06 |
Total Medical Medicare Payment Amount |
11289.99 |
Total Medical Medicare Standardized Payment Amount |
14747.16 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
33 |
Number Of Beneficiaries Age 65 to 74 |
43 |
Number Of Beneficiaries Age 75 to 84 |
32 |
Number Of Beneficiaries Age Greater 84 |
14 |
Number Of Female Beneficiaries |
97 |
Number Of Male Beneficiaries |
25 |
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 |
69 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
53 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
10 |
Percent Of With Chronic Kidney Disease |
13 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
28 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
56 |
Percent Of With Hypertension |
62 |
Percent Of With Ischemic Heart Disease |
19 |
Percent Of With Osteoporosis |
16 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1308 |