National Provider Identifier [NPI]: |
1952626673 |
Last Name Of The Provider |
MOJA |
First Name Of The Provider |
ASHLEY |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
|
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
430 WARRENVILLE RD |
Street Address 2 Of The Provider |
210 |
City Of The Provider |
LISLE |
Zip Code Of The Provider |
605321348 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
56 |
Number Of Services |
651 |
Number Of Medicare Beneficiaries |
198 |
Total Submitted Charge Amount |
72499 |
Total Medicare Allowed Amount |
33151.79 |
Total Medicare Payment Amount |
24469.12 |
Total Medicare Standardized Payment Amount |
22737.6 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
20 |
Number Of Medicare Beneficiaries With Drug Services |
17 |
Total Drug Submitted ChargeAmount |
1045 |
Total Drug Medicare AllowedAmount |
653.41 |
Total Drug Medicare PaymentAmount |
639.45 |
Total Drug Medicare Standardized Payment Amount |
639.45 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
51 |
Number Of Medical Services |
631 |
Number Of Medicare Beneficiaries With Medical Services |
198 |
Total Medical Submitted Charge Amount |
71454 |
Total Medical Medicare Allowed Amount |
32498.38 |
Total Medical Medicare Payment Amount |
23829.67 |
Total Medical Medicare Standardized Payment Amount |
22098.15 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
11 |
Number Of Beneficiaries Age 65 to 74 |
116 |
Number Of Beneficiaries Age 75 to 84 |
51 |
Number Of Beneficiaries Age Greater 84 |
20 |
Number Of Female Beneficiaries |
139 |
Number Of Male Beneficiaries |
59 |
Number Of Non Hispanic White Beneficiaries |
184 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
17 |
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
10 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
17 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
47 |
Percent Of With Hypertension |
51 |
Percent Of With Ischemic Heart Disease |
22 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
0.8593 |