National Provider Identifier [NPI]: |
1063517761 |
Last Name Of The Provider |
HANEFFANT |
First Name Of The Provider |
MARIA-DOLORES |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
PA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3100 DOUGLAS BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
ROSEVILLE |
Zip Code Of The Provider |
956613866 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
37 |
Number Of Services |
532 |
Number Of Medicare Beneficiaries |
244 |
Total Submitted Charge Amount |
138864 |
Total Medicare Allowed Amount |
40778.92 |
Total Medicare Payment Amount |
28337.14 |
Total Medicare Standardized Payment Amount |
32472.47 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
51 |
Number Of Medicare Beneficiaries With Drug Services |
39 |
Total Drug Submitted ChargeAmount |
2312 |
Total Drug Medicare AllowedAmount |
1641.32 |
Total Drug Medicare PaymentAmount |
1602.99 |
Total Drug Medicare Standardized Payment Amount |
1602.99 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
30 |
Number Of Medical Services |
481 |
Number Of Medicare Beneficiaries With Medical Services |
243 |
Total Medical Submitted Charge Amount |
136552 |
Total Medical Medicare Allowed Amount |
39137.6 |
Total Medical Medicare Payment Amount |
26734.15 |
Total Medical Medicare Standardized Payment Amount |
30869.48 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
62 |
Number Of Beneficiaries Age 65 to 74 |
108 |
Number Of Beneficiaries Age 75 to 84 |
50 |
Number Of Beneficiaries Age Greater 84 |
24 |
Number Of Female Beneficiaries |
161 |
Number Of Male Beneficiaries |
83 |
Number Of Non Hispanic White Beneficiaries |
197 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
17 |
Number Of Hispanic Beneficiaries |
19 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
184 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
60 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
28 |
Percent Of With Diabetes |
24 |
Percent Of With Hyperlipidemia |
53 |
Percent Of With Hypertension |
58 |
Percent Of With Ischemic Heart Disease |
23 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1321 |