National Provider Identifier [NPI]: |
1295176196 |
Last Name Of The Provider |
FERGUSON |
First Name Of The Provider |
SARAH |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
NP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
240 MEDICAL PARK BLVD |
Street Address 2 Of The Provider |
STE 3600 |
City Of The Provider |
BRISTOL |
Zip Code Of The Provider |
376207346 |
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 |
65 |
Number Of Services |
900 |
Number Of Medicare Beneficiaries |
356 |
Total Submitted Charge Amount |
85818 |
Total Medicare Allowed Amount |
38875.89 |
Total Medicare Payment Amount |
29271.42 |
Total Medicare Standardized Payment Amount |
37722.32 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
13 |
Number Of Drug Services |
113 |
Number Of Medicare Beneficiaries With Drug Services |
45 |
Total Drug Submitted ChargeAmount |
2964 |
Total Drug Medicare AllowedAmount |
1241.4 |
Total Drug Medicare PaymentAmount |
1135.41 |
Total Drug Medicare Standardized Payment Amount |
1135.41 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
52 |
Number Of Medical Services |
787 |
Number Of Medicare Beneficiaries With Medical Services |
356 |
Total Medical Submitted Charge Amount |
82854 |
Total Medical Medicare Allowed Amount |
37634.49 |
Total Medical Medicare Payment Amount |
28136.01 |
Total Medical Medicare Standardized Payment Amount |
36586.91 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
68 |
Number Of Beneficiaries Age 65 to 74 |
139 |
Number Of Beneficiaries Age 75 to 84 |
106 |
Number Of Beneficiaries Age Greater 84 |
43 |
Number Of Female Beneficiaries |
221 |
Number Of Male Beneficiaries |
135 |
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 |
290 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
66 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
28 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
53 |
Percent Of With Hypertension |
74 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.0646 |