National Provider Identifier [NPI]: |
1487811527 |
Last Name Of The Provider |
NOCK |
First Name Of The Provider |
CRYSTAL |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
FNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3080 COLLEGE ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
BEAUMONT |
Zip Code Of The Provider |
777014606 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
18 |
Number Of Services |
291 |
Number Of Medicare Beneficiaries |
249 |
Total Submitted Charge Amount |
238675 |
Total Medicare Allowed Amount |
28319.83 |
Total Medicare Payment Amount |
22067.43 |
Total Medicare Standardized Payment Amount |
26558.19 |
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 |
18 |
Number Of Medical Services |
291 |
Number Of Medicare Beneficiaries With Medical Services |
249 |
Total Medical Submitted Charge Amount |
238675 |
Total Medical Medicare Allowed Amount |
28319.83 |
Total Medical Medicare Payment Amount |
22067.43 |
Total Medical Medicare Standardized Payment Amount |
26558.19 |
Average Age Of Beneficiaries |
64 |
Number Of Beneficiaries Age Less65 |
112 |
Number Of Beneficiaries Age 65 to 74 |
63 |
Number Of Beneficiaries Age 75 to 84 |
50 |
Number Of Beneficiaries Age Greater 84 |
24 |
Number Of Female Beneficiaries |
155 |
Number Of Male Beneficiaries |
94 |
Number Of Non Hispanic White Beneficiaries |
133 |
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 |
113 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
136 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
21 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
4 |
Percent Of With Heart Failure |
30 |
Percent Of With Chronic Kidney Disease |
29 |
Percent Of With Chronic Obstructive Pulmonary Disease |
26 |
Percent Of With Depression |
32 |
Percent Of With Diabetes |
37 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
45 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
41 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.729 |