National Provider Identifier [NPI]: |
1003896770 |
Last Name Of The Provider |
SANE |
First Name Of The Provider |
ANEYSA |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
108 DORNACH WAY |
Street Address 2 Of The Provider |
SUITE 200 |
City Of The Provider |
ADVANCE |
Zip Code Of The Provider |
270067305 |
State Code Of The Provider |
NC |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Allergy/Immunology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
43 |
Number Of Services |
5521 |
Number Of Medicare Beneficiaries |
117 |
Total Submitted Charge Amount |
216528 |
Total Medicare Allowed Amount |
156134.58 |
Total Medicare Payment Amount |
120988.15 |
Total Medicare Standardized Payment Amount |
119530.13 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
4275 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
153645 |
Total Drug Medicare AllowedAmount |
113130.83 |
Total Drug Medicare PaymentAmount |
88614.78 |
Total Drug Medicare Standardized Payment Amount |
88614.78 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
34 |
Number Of Medical Services |
1246 |
Number Of Medicare Beneficiaries With Medical Services |
117 |
Total Medical Submitted Charge Amount |
62883 |
Total Medical Medicare Allowed Amount |
43003.75 |
Total Medical Medicare Payment Amount |
32373.37 |
Total Medical Medicare Standardized Payment Amount |
30915.35 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
28 |
Number Of Beneficiaries Age 65 to 74 |
59 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
76 |
Number Of Male Beneficiaries |
41 |
Number Of Non Hispanic White Beneficiaries |
97 |
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 |
96 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
21 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
24 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
10 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
56 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
24 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8729 |