National Provider Identifier [NPI]: |
1124274071 |
Last Name Of The Provider |
CALDERONE |
First Name Of The Provider |
MARY |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
M.A.C.C.C.A. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
360 E LOSEY ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
GALESBURG |
Zip Code Of The Provider |
614012843 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Audiologist (billing independently) |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
4 |
Number Of Services |
220 |
Number Of Medicare Beneficiaries |
172 |
Total Submitted Charge Amount |
21008 |
Total Medicare Allowed Amount |
7536.34 |
Total Medicare Payment Amount |
4719.92 |
Total Medicare Standardized Payment Amount |
5145.06 |
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 |
4 |
Number Of Medical Services |
220 |
Number Of Medicare Beneficiaries With Medical Services |
172 |
Total Medical Submitted Charge Amount |
21008 |
Total Medical Medicare Allowed Amount |
7536.34 |
Total Medical Medicare Payment Amount |
4719.92 |
Total Medical Medicare Standardized Payment Amount |
5145.06 |
Average Age Of Beneficiaries |
78 |
Number Of Beneficiaries Age Less65 |
11 |
Number Of Beneficiaries Age 65 to 74 |
61 |
Number Of Beneficiaries Age 75 to 84 |
47 |
Number Of Beneficiaries Age Greater 84 |
53 |
Number Of Female Beneficiaries |
96 |
Number Of Male Beneficiaries |
76 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
13 |
Percent Of With Diabetes |
27 |
Percent Of With Hyperlipidemia |
52 |
Percent Of With Hypertension |
63 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
41 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.2303 |