National Provider Identifier [NPI]: |
1366773301 |
Last Name Of The Provider |
TAYLOR |
First Name Of The Provider |
PRESTON |
Middle Initial Of The Provider |
K |
Credentials Of The Provider |
CRNA |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1305 WONDER WORLD DR |
Street Address 2 Of The Provider |
SUITE 105 |
City Of The Provider |
SAN MARCOS |
Zip Code Of The Provider |
786667546 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
49 |
Number Of Services |
237 |
Number Of Medicare Beneficiaries |
237 |
Total Submitted Charge Amount |
202104 |
Total Medicare Allowed Amount |
32095.35 |
Total Medicare Payment Amount |
24927.34 |
Total Medicare Standardized Payment Amount |
25862.26 |
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 |
49 |
Number Of Medical Services |
237 |
Number Of Medicare Beneficiaries With Medical Services |
237 |
Total Medical Submitted Charge Amount |
202104 |
Total Medical Medicare Allowed Amount |
32095.35 |
Total Medical Medicare Payment Amount |
24927.34 |
Total Medical Medicare Standardized Payment Amount |
25862.26 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
33 |
Number Of Beneficiaries Age 65 to 74 |
132 |
Number Of Beneficiaries Age 75 to 84 |
56 |
Number Of Beneficiaries Age Greater 84 |
16 |
Number Of Female Beneficiaries |
114 |
Number Of Male Beneficiaries |
123 |
Number Of Non Hispanic White Beneficiaries |
180 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
36 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
203 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
34 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
24 |
Percent Of With Chronic Kidney Disease |
31 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
34 |
Percent Of With Hyperlipidemia |
64 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
40 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.5992 |