National Provider Identifier [NPI]: |
1972896850 |
Last Name Of The Provider |
PHARAOH |
First Name Of The Provider |
VIRGINIA |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
APN |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2240 SUTHERLAND AVE |
Street Address 2 Of The Provider |
SUITE 104 |
City Of The Provider |
KNOXVILLE |
Zip Code Of The Provider |
379192333 |
State Code Of The Provider |
TN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
7 |
Number Of Services |
1197 |
Number Of Medicare Beneficiaries |
441 |
Total Submitted Charge Amount |
141281 |
Total Medicare Allowed Amount |
61705.69 |
Total Medicare Payment Amount |
45254.93 |
Total Medicare Standardized Payment Amount |
58349.58 |
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 |
7 |
Number Of Medical Services |
1197 |
Number Of Medicare Beneficiaries With Medical Services |
441 |
Total Medical Submitted Charge Amount |
141281 |
Total Medical Medicare Allowed Amount |
61705.69 |
Total Medical Medicare Payment Amount |
45254.93 |
Total Medical Medicare Standardized Payment Amount |
58349.58 |
Average Age Of Beneficiaries |
83 |
Number Of Beneficiaries Age Less65 |
14 |
Number Of Beneficiaries Age 65 to 74 |
53 |
Number Of Beneficiaries Age 75 to 84 |
144 |
Number Of Beneficiaries Age Greater 84 |
230 |
Number Of Female Beneficiaries |
318 |
Number Of Male Beneficiaries |
123 |
Number Of Non Hispanic White Beneficiaries |
413 |
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 |
250 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
191 |
Percent Of With Atrial Fibrillation |
30 |
Percent Of With Alzheimers Disease or Dementia |
66 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
51 |
Percent Of With Chronic Kidney Disease |
58 |
Percent Of With Chronic Obstructive Pulmonary Disease |
32 |
Percent Of With Depression |
61 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
50 |
Percent Of With Osteoporosis |
21 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
51 |
Percent Of With Schizophrenia Other PsychoticDisorders |
30 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
2.0508 |