National Provider Identifier [NPI]: |
1295073815 |
Last Name Of The Provider |
WRITER |
First Name Of The Provider |
NICOLE |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6715 W HIGHWAY 98 |
Street Address 2 Of The Provider |
|
City Of The Provider |
PENSACOLA |
Zip Code Of The Provider |
325065923 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
79 |
Number Of Services |
888 |
Number Of Medicare Beneficiaries |
369 |
Total Submitted Charge Amount |
84007 |
Total Medicare Allowed Amount |
48644.35 |
Total Medicare Payment Amount |
33457.96 |
Total Medicare Standardized Payment Amount |
40297.14 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
14 |
Number Of Drug Services |
127 |
Number Of Medicare Beneficiaries With Drug Services |
69 |
Total Drug Submitted ChargeAmount |
2585 |
Total Drug Medicare AllowedAmount |
682.41 |
Total Drug Medicare PaymentAmount |
581.87 |
Total Drug Medicare Standardized Payment Amount |
581.87 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
65 |
Number Of Medical Services |
761 |
Number Of Medicare Beneficiaries With Medical Services |
369 |
Total Medical Submitted Charge Amount |
81422 |
Total Medical Medicare Allowed Amount |
47961.94 |
Total Medical Medicare Payment Amount |
32876.09 |
Total Medical Medicare Standardized Payment Amount |
39715.27 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
73 |
Number Of Beneficiaries Age 65 to 74 |
142 |
Number Of Beneficiaries Age 75 to 84 |
111 |
Number Of Beneficiaries Age Greater 84 |
43 |
Number Of Female Beneficiaries |
225 |
Number Of Male Beneficiaries |
144 |
Number Of Non Hispanic White Beneficiaries |
330 |
Number Of Black or African American Beneficiaries |
26 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
305 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
64 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
24 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
21 |
Percent Of With Depression |
37 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
53 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
42 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
49 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.2275 |