National Provider Identifier [NPI]: |
1528497906 |
Last Name Of The Provider |
MOMPLAISIR |
First Name Of The Provider |
MARGARONE |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
|
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
107 S GARDNER ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
FALFURRIAS |
Zip Code Of The Provider |
783554217 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
31 |
Number Of Services |
664 |
Number Of Medicare Beneficiaries |
108 |
Total Submitted Charge Amount |
73657 |
Total Medicare Allowed Amount |
31546.63 |
Total Medicare Payment Amount |
23538.9 |
Total Medicare Standardized Payment Amount |
29194.7 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
11 |
Number Of Drug Services |
108 |
Number Of Medicare Beneficiaries With Drug Services |
26 |
Total Drug Submitted ChargeAmount |
2322 |
Total Drug Medicare AllowedAmount |
290.39 |
Total Drug Medicare PaymentAmount |
253.03 |
Total Drug Medicare Standardized Payment Amount |
253.03 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
20 |
Number Of Medical Services |
556 |
Number Of Medicare Beneficiaries With Medical Services |
108 |
Total Medical Submitted Charge Amount |
71335 |
Total Medical Medicare Allowed Amount |
31256.24 |
Total Medical Medicare Payment Amount |
23285.87 |
Total Medical Medicare Standardized Payment Amount |
28941.67 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
34 |
Number Of Beneficiaries Age 65 to 74 |
29 |
Number Of Beneficiaries Age 75 to 84 |
34 |
Number Of Beneficiaries Age Greater 84 |
11 |
Number Of Female Beneficiaries |
69 |
Number Of Male Beneficiaries |
39 |
Number Of Non Hispanic White Beneficiaries |
13 |
Number Of Black or African American Beneficiaries |
0 |
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
95 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
0 |
Number Of Beneficiaries With Medicare Only Entitlement |
46 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
62 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
15 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
36 |
Percent Of With Diabetes |
62 |
Percent Of With Hyperlipidemia |
67 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
49 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
59 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2455 |