National Provider Identifier [NPI]: |
1205871589 |
Last Name Of The Provider |
PETTIT |
First Name Of The Provider |
WENDY |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
NP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
601 ELMWOOD AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
ROCHESTER |
Zip Code Of The Provider |
146420002 |
State Code Of The Provider |
NY |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
6 |
Number Of Services |
640 |
Number Of Medicare Beneficiaries |
252 |
Total Submitted Charge Amount |
68121 |
Total Medicare Allowed Amount |
42342.35 |
Total Medicare Payment Amount |
30741.79 |
Total Medicare Standardized Payment Amount |
37983.72 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
|
Number Of Drug Services |
|
Number Of Medicare Beneficiaries With Drug Services |
|
Total Drug Submitted ChargeAmount |
|
Total Drug Medicare AllowedAmount |
|
Total Drug Medicare PaymentAmount |
|
Total Drug Medicare Standardized Payment Amount |
|
Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
|
Number Of Medical Services |
|
Number Of Medicare Beneficiaries With Medical Services |
|
Total Medical Submitted Charge Amount |
|
Total Medical Medicare Allowed Amount |
|
Total Medical Medicare Payment Amount |
|
Total Medical Medicare Standardized Payment Amount |
|
Average Age Of Beneficiaries |
52 |
Number Of Beneficiaries Age Less65 |
215 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
100 |
Number Of Male Beneficiaries |
152 |
Number Of Non Hispanic White Beneficiaries |
159 |
Number Of Black or African American Beneficiaries |
69 |
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 |
18 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
234 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
11 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
7 |
Percent Of With Chronic Kidney Disease |
19 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
44 |
Percent Of With Hyperlipidemia |
39 |
Percent Of With Hypertension |
58 |
Percent Of With Ischemic Heart Disease |
13 |
Percent Of With Osteoporosis |
4 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
13 |
Percent Of With Schizophrenia Other PsychoticDisorders |
75 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2857 |