National Provider Identifier [NPI]: |
1841463098 |
Last Name Of The Provider |
FEIN |
First Name Of The Provider |
JORDANA |
Middle Initial Of The Provider |
G |
Credentials Of The Provider |
M.D., M.S. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6845 ELM ST |
Street Address 2 Of The Provider |
SUITE 611 |
City Of The Provider |
MC LEAN |
Zip Code Of The Provider |
221016007 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Ophthalmology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
44 |
Number Of Services |
1705 |
Number Of Medicare Beneficiaries |
355 |
Total Submitted Charge Amount |
506641.98 |
Total Medicare Allowed Amount |
278239.03 |
Total Medicare Payment Amount |
211828.45 |
Total Medicare Standardized Payment Amount |
204087.56 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
446 |
Number Of Medicare Beneficiaries With Drug Services |
75 |
Total Drug Submitted ChargeAmount |
171759.48 |
Total Drug Medicare AllowedAmount |
137668.9 |
Total Drug Medicare PaymentAmount |
107440.3 |
Total Drug Medicare Standardized Payment Amount |
107440.3 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
39 |
Number Of Medical Services |
1259 |
Number Of Medicare Beneficiaries With Medical Services |
355 |
Total Medical Submitted Charge Amount |
334882.5 |
Total Medical Medicare Allowed Amount |
140570.13 |
Total Medical Medicare Payment Amount |
104388.15 |
Total Medical Medicare Standardized Payment Amount |
96647.26 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
31 |
Number Of Beneficiaries Age 65 to 74 |
118 |
Number Of Beneficiaries Age 75 to 84 |
135 |
Number Of Beneficiaries Age Greater 84 |
71 |
Number Of Female Beneficiaries |
199 |
Number Of Male Beneficiaries |
156 |
Number Of Non Hispanic White Beneficiaries |
296 |
Number Of Black or African American Beneficiaries |
22 |
Number Of AsianPacific Islander Beneficiaries |
19 |
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 |
286 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
69 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
34 |
Percent Of With Hyperlipidemia |
58 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.4488 |