National Provider Identifier [NPI]: |
1861654014 |
Last Name Of The Provider |
HOSTETLER |
First Name Of The Provider |
SARAH |
Middle Initial Of The Provider |
G |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1654 UPHAM DR |
Street Address 2 Of The Provider |
207 MEANS HALL |
City Of The Provider |
COLUMBUS |
Zip Code Of The Provider |
432101250 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Dermatology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
64 |
Number Of Services |
3369 |
Number Of Medicare Beneficiaries |
450 |
Total Submitted Charge Amount |
441161 |
Total Medicare Allowed Amount |
121475.2 |
Total Medicare Payment Amount |
89580.72 |
Total Medicare Standardized Payment Amount |
92890.96 |
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 |
64 |
Number Of Medical Services |
3369 |
Number Of Medicare Beneficiaries With Medical Services |
450 |
Total Medical Submitted Charge Amount |
441161 |
Total Medical Medicare Allowed Amount |
121475.2 |
Total Medical Medicare Payment Amount |
89580.72 |
Total Medical Medicare Standardized Payment Amount |
92890.96 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
51 |
Number Of Beneficiaries Age 65 to 74 |
204 |
Number Of Beneficiaries Age 75 to 84 |
142 |
Number Of Beneficiaries Age Greater 84 |
53 |
Number Of Female Beneficiaries |
265 |
Number Of Male Beneficiaries |
185 |
Number Of Non Hispanic White Beneficiaries |
436 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
0 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
395 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
55 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
5 |
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 |
9 |
Percent Of With Depression |
20 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
63 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0878 |