National Provider Identifier [NPI]: |
1538394366 |
Last Name Of The Provider |
MCCOY |
First Name Of The Provider |
ANGELA |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
CRNA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
7601 SOUTHCREST PKWY |
Street Address 2 Of The Provider |
|
City Of The Provider |
SOUTHAVEN |
Zip Code Of The Provider |
386714739 |
State Code Of The Provider |
MS |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
57 |
Number Of Services |
230 |
Number Of Medicare Beneficiaries |
222 |
Total Submitted Charge Amount |
129906 |
Total Medicare Allowed Amount |
30033.68 |
Total Medicare Payment Amount |
23493.2 |
Total Medicare Standardized Payment Amount |
24738.27 |
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 |
57 |
Number Of Medical Services |
230 |
Number Of Medicare Beneficiaries With Medical Services |
222 |
Total Medical Submitted Charge Amount |
129906 |
Total Medical Medicare Allowed Amount |
30033.68 |
Total Medical Medicare Payment Amount |
23493.2 |
Total Medical Medicare Standardized Payment Amount |
24738.27 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
61 |
Number Of Beneficiaries Age 65 to 74 |
100 |
Number Of Beneficiaries Age 75 to 84 |
45 |
Number Of Beneficiaries Age Greater 84 |
16 |
Number Of Female Beneficiaries |
114 |
Number Of Male Beneficiaries |
108 |
Number Of Non Hispanic White Beneficiaries |
207 |
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 |
144 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
78 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
26 |
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
31 |
Percent Of With Depression |
37 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
56 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2401 |