National Provider Identifier [NPI]: |
1992748750 |
Last Name Of The Provider |
BRAY |
First Name Of The Provider |
BRENDA |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
PA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1501 W CHISHOLM ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
ALPENA |
Zip Code Of The Provider |
497071401 |
State Code Of The Provider |
MI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
12 |
Number Of Services |
414 |
Number Of Medicare Beneficiaries |
380 |
Total Submitted Charge Amount |
57828 |
Total Medicare Allowed Amount |
36402.21 |
Total Medicare Payment Amount |
22595.7 |
Total Medicare Standardized Payment Amount |
29166.5 |
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 |
12 |
Number Of Medical Services |
414 |
Number Of Medicare Beneficiaries With Medical Services |
380 |
Total Medical Submitted Charge Amount |
57828 |
Total Medical Medicare Allowed Amount |
36402.21 |
Total Medical Medicare Payment Amount |
22595.7 |
Total Medical Medicare Standardized Payment Amount |
29166.5 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
41 |
Number Of Beneficiaries Age 65 to 74 |
128 |
Number Of Beneficiaries Age 75 to 84 |
140 |
Number Of Beneficiaries Age Greater 84 |
71 |
Number Of Female Beneficiaries |
209 |
Number Of Male Beneficiaries |
171 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
307 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
73 |
Percent Of With Atrial Fibrillation |
16 |
Percent Of With Alzheimers Disease or Dementia |
13 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
42 |
Percent Of With Chronic Kidney Disease |
75 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
21 |
Percent Of With Diabetes |
59 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
43 |
Percent Of With Osteoporosis |
4 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.8557 |