National Provider Identifier [NPI]: |
1174802938 |
Last Name Of The Provider |
KELLEY |
First Name Of The Provider |
STACY |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
CNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6515 PULLMAN DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
LEWIS CENTER |
Zip Code Of The Provider |
430357380 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
117 |
Number Of Medicare Beneficiaries |
73 |
Total Submitted Charge Amount |
15947.4 |
Total Medicare Allowed Amount |
7787.17 |
Total Medicare Payment Amount |
5683.91 |
Total Medicare Standardized Payment Amount |
6999.71 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
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Number Of Drug Services |
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Number Of Medicare Beneficiaries With Drug Services |
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Total Drug Submitted ChargeAmount |
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Total Drug Medicare AllowedAmount |
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Total Drug Medicare PaymentAmount |
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Total Drug Medicare Standardized Payment Amount |
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Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
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Number Of Medical Services |
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Number Of Medicare Beneficiaries With Medical Services |
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Total Medical Submitted Charge Amount |
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Total Medical Medicare Allowed Amount |
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Total Medical Medicare Payment Amount |
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Total Medical Medicare Standardized Payment Amount |
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Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
15 |
Number Of Beneficiaries Age 65 to 74 |
43 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
49 |
Number Of Male Beneficiaries |
24 |
Number Of Non Hispanic White Beneficiaries |
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Number Of Black or African American Beneficiaries |
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Number Of AsianPacific Islander Beneficiaries |
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Number Of Hispanic Beneficiaries |
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Number Of American Indian Alaska Native Beneficiaries |
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Number Of Beneficiaries With Race Not Else where Classified |
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Number Of Beneficiaries With Medicare Only Entitlement |
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Number Of Beneficiaries With Medicare Medicaid Entitlement |
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Percent Of With Atrial Fibrillation |
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Percent Of With Alzheimers Disease or Dementia |
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Percent Of With Asthma |
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Percent Of With Cancer |
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Percent Of With Heart Failure |
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Percent Of With Chronic Kidney Disease |
19 |
Percent Of With Chronic Obstructive Pulmonary Disease |
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Percent Of With Depression |
21 |
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
49 |
Percent Of With Hypertension |
60 |
Percent Of With Ischemic Heart Disease |
21 |
Percent Of With Osteoporosis |
18 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
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Percent Of With Stroke |
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Average HCC Risk Score Of Beneficiaries |
1.0721 |