National Provider Identifier [NPI]: |
1407288624 |
Last Name Of The Provider |
PEMBERTON |
First Name Of The Provider |
SHARON |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
FNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6360 HOADLY RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
MANASSAS |
Zip Code Of The Provider |
201123422 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
18 |
Number Of Services |
204 |
Number Of Medicare Beneficiaries |
96 |
Total Submitted Charge Amount |
7199.18 |
Total Medicare Allowed Amount |
6725.31 |
Total Medicare Payment Amount |
5924.89 |
Total Medicare Standardized Payment Amount |
6595.49 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
82 |
Number Of Medicare Beneficiaries With Drug Services |
74 |
Total Drug Submitted ChargeAmount |
2771.18 |
Total Drug Medicare AllowedAmount |
2771.18 |
Total Drug Medicare PaymentAmount |
2704.97 |
Total Drug Medicare Standardized Payment Amount |
2704.97 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
14 |
Number Of Medical Services |
122 |
Number Of Medicare Beneficiaries With Medical Services |
95 |
Total Medical Submitted Charge Amount |
4428 |
Total Medical Medicare Allowed Amount |
3954.13 |
Total Medical Medicare Payment Amount |
3219.92 |
Total Medical Medicare Standardized Payment Amount |
3890.52 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
51 |
Number Of Beneficiaries Age 75 to 84 |
29 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
54 |
Number Of Male Beneficiaries |
42 |
Number Of Non Hispanic White Beneficiaries |
85 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
15 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
11 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
60 |
Percent Of With Ischemic Heart Disease |
31 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
31 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8593 |