National Provider Identifier [NPI]: |
1811056609 |
Last Name Of The Provider |
GIBSON |
First Name Of The Provider |
MELINDA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
CRNA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
9601 INTERSTATE 630 EXIT 7 |
Street Address 2 Of The Provider |
|
City Of The Provider |
LITTLE ROCK |
Zip Code Of The Provider |
722057202 |
State Code Of The Provider |
AR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
14 |
Number Of Services |
415 |
Number Of Medicare Beneficiaries |
396 |
Total Submitted Charge Amount |
267988 |
Total Medicare Allowed Amount |
66968.63 |
Total Medicare Payment Amount |
51935.96 |
Total Medicare Standardized Payment Amount |
55513.53 |
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 |
14 |
Number Of Medical Services |
415 |
Number Of Medicare Beneficiaries With Medical Services |
396 |
Total Medical Submitted Charge Amount |
267988 |
Total Medical Medicare Allowed Amount |
66968.63 |
Total Medical Medicare Payment Amount |
51935.96 |
Total Medical Medicare Standardized Payment Amount |
55513.53 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
29 |
Number Of Beneficiaries Age 65 to 74 |
195 |
Number Of Beneficiaries Age 75 to 84 |
137 |
Number Of Beneficiaries Age Greater 84 |
35 |
Number Of Female Beneficiaries |
244 |
Number Of Male Beneficiaries |
152 |
Number Of Non Hispanic White Beneficiaries |
365 |
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 |
355 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
41 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
24 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
12 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
16 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
49 |
Percent Of With Hypertension |
66 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
29 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.0091 |