National Provider Identifier [NPI]: |
1104255785 |
Last Name Of The Provider |
MILES |
First Name Of The Provider |
SARAH |
Middle Initial Of The Provider |
V |
Credentials Of The Provider |
PHYSICIANS ASSISTANT |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3124 S 19TH ST # 320 |
Street Address 2 Of The Provider |
|
City Of The Provider |
TACOMA |
Zip Code Of The Provider |
984052433 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
25 |
Number Of Services |
313 |
Number Of Medicare Beneficiaries |
81 |
Total Submitted Charge Amount |
47434 |
Total Medicare Allowed Amount |
16995.44 |
Total Medicare Payment Amount |
13276.48 |
Total Medicare Standardized Payment Amount |
14843.88 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
119 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
14295 |
Total Drug Medicare AllowedAmount |
6057.37 |
Total Drug Medicare PaymentAmount |
4749.07 |
Total Drug Medicare Standardized Payment Amount |
4749.07 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
22 |
Number Of Medical Services |
194 |
Number Of Medicare Beneficiaries With Medical Services |
81 |
Total Medical Submitted Charge Amount |
33139 |
Total Medical Medicare Allowed Amount |
10938.07 |
Total Medical Medicare Payment Amount |
8527.41 |
Total Medical Medicare Standardized Payment Amount |
10094.81 |
Average Age Of Beneficiaries |
78 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
32 |
Number Of Beneficiaries Age Greater 84 |
23 |
Number Of Female Beneficiaries |
41 |
Number Of Male Beneficiaries |
40 |
Number Of Non Hispanic White Beneficiaries |
70 |
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 |
69 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
12 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
|
Percent Of With Cancer |
19 |
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
42 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
26 |
Percent Of With Diabetes |
21 |
Percent Of With Hyperlipidemia |
68 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.3524 |