National Provider Identifier [NPI]: |
1497702096 |
Last Name Of The Provider |
PRUITT |
First Name Of The Provider |
MELISSA |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
ACNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
877 JEFFERSON AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
MEMPHIS |
Zip Code Of The Provider |
381032807 |
State Code Of The Provider |
TN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
682 |
Number Of Medicare Beneficiaries |
63 |
Total Submitted Charge Amount |
24164 |
Total Medicare Allowed Amount |
16570.61 |
Total Medicare Payment Amount |
12962.09 |
Total Medicare Standardized Payment Amount |
16082.93 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
303 |
Number Of Medicare Beneficiaries With Drug Services |
49 |
Total Drug Submitted ChargeAmount |
1896 |
Total Drug Medicare AllowedAmount |
1468.22 |
Total Drug Medicare PaymentAmount |
1145.17 |
Total Drug Medicare Standardized Payment Amount |
1145.17 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
13 |
Number Of Medical Services |
379 |
Number Of Medicare Beneficiaries With Medical Services |
63 |
Total Medical Submitted Charge Amount |
22268 |
Total Medical Medicare Allowed Amount |
15102.39 |
Total Medical Medicare Payment Amount |
11816.92 |
Total Medical Medicare Standardized Payment Amount |
14937.76 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
37 |
Number Of Beneficiaries Age 75 to 84 |
12 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
|
Number Of Male Beneficiaries |
|
Number Of Non Hispanic White Beneficiaries |
46 |
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 |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
63 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
27 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9184 |