National Provider Identifier [NPI]: |
1205269305 |
Last Name Of The Provider |
BLOCKER |
First Name Of The Provider |
TYLER |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
CRNA |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1068 CRESTHAVEN RD |
Street Address 2 Of The Provider |
SUITE 150 |
City Of The Provider |
MEMPHIS |
Zip Code Of The Provider |
381190800 |
State Code Of The Provider |
TN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
54 |
Number Of Services |
169 |
Number Of Medicare Beneficiaries |
165 |
Total Submitted Charge Amount |
195092.8 |
Total Medicare Allowed Amount |
38391.91 |
Total Medicare Payment Amount |
29925.8 |
Total Medicare Standardized Payment Amount |
31810.8 |
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 |
54 |
Number Of Medical Services |
169 |
Number Of Medicare Beneficiaries With Medical Services |
165 |
Total Medical Submitted Charge Amount |
195092.8 |
Total Medical Medicare Allowed Amount |
38391.91 |
Total Medical Medicare Payment Amount |
29925.8 |
Total Medical Medicare Standardized Payment Amount |
31810.8 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
34 |
Number Of Beneficiaries Age 65 to 74 |
78 |
Number Of Beneficiaries Age 75 to 84 |
39 |
Number Of Beneficiaries Age Greater 84 |
14 |
Number Of Female Beneficiaries |
79 |
Number Of Male Beneficiaries |
86 |
Number Of Non Hispanic White Beneficiaries |
130 |
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 |
122 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
43 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
13 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
29 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
28 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
62 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.512 |