National Provider Identifier [NPI]: |
1285993105 |
Last Name Of The Provider |
RAU |
First Name Of The Provider |
MARY |
Middle Initial Of The Provider |
K |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
49 HOSIERY MILL RD |
Street Address 2 Of The Provider |
124 |
City Of The Provider |
DALLAS |
Zip Code Of The Provider |
301571687 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
38 |
Number Of Services |
360 |
Number Of Medicare Beneficiaries |
263 |
Total Submitted Charge Amount |
220106 |
Total Medicare Allowed Amount |
29411.91 |
Total Medicare Payment Amount |
22914.98 |
Total Medicare Standardized Payment Amount |
27648 |
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 |
38 |
Number Of Medical Services |
360 |
Number Of Medicare Beneficiaries With Medical Services |
263 |
Total Medical Submitted Charge Amount |
220106 |
Total Medical Medicare Allowed Amount |
29411.91 |
Total Medical Medicare Payment Amount |
22914.98 |
Total Medical Medicare Standardized Payment Amount |
27648 |
Average Age Of Beneficiaries |
65 |
Number Of Beneficiaries Age Less65 |
108 |
Number Of Beneficiaries Age 65 to 74 |
80 |
Number Of Beneficiaries Age 75 to 84 |
52 |
Number Of Beneficiaries Age Greater 84 |
23 |
Number Of Female Beneficiaries |
149 |
Number Of Male Beneficiaries |
114 |
Number Of Non Hispanic White Beneficiaries |
234 |
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 |
125 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
138 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
19 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
33 |
Percent Of With Chronic Kidney Disease |
35 |
Percent Of With Chronic Obstructive Pulmonary Disease |
37 |
Percent Of With Depression |
40 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
52 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.705 |