National Provider Identifier [NPI]: |
1679577951 |
Last Name Of The Provider |
BUTCHER |
First Name Of The Provider |
SARAH |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
CRNA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3400 DEXTER CT |
Street Address 2 Of The Provider |
|
City Of The Provider |
DAVENPORT |
Zip Code Of The Provider |
528073461 |
State Code Of The Provider |
IA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
36 |
Number Of Services |
152 |
Number Of Medicare Beneficiaries |
137 |
Total Submitted Charge Amount |
120840 |
Total Medicare Allowed Amount |
22580.97 |
Total Medicare Payment Amount |
17541.76 |
Total Medicare Standardized Payment Amount |
18844.57 |
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 |
36 |
Number Of Medical Services |
152 |
Number Of Medicare Beneficiaries With Medical Services |
137 |
Total Medical Submitted Charge Amount |
120840 |
Total Medical Medicare Allowed Amount |
22580.97 |
Total Medical Medicare Payment Amount |
17541.76 |
Total Medical Medicare Standardized Payment Amount |
18844.57 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
74 |
Number Of Beneficiaries Age 75 to 84 |
34 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
88 |
Number Of Male Beneficiaries |
49 |
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 |
116 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
21 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
9 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
26 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
65 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.099 |