National Provider Identifier [NPI]: |
1669446951 |
Last Name Of The Provider |
SANDERS |
First Name Of The Provider |
LISA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
140 GRANDVIEW AVE |
Street Address 2 Of The Provider |
SUITE #101 |
City Of The Provider |
WATERBURY |
Zip Code Of The Provider |
067082505 |
State Code Of The Provider |
CT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
22 |
Number Of Services |
348 |
Number Of Medicare Beneficiaries |
206 |
Total Submitted Charge Amount |
68319 |
Total Medicare Allowed Amount |
25891.98 |
Total Medicare Payment Amount |
18333.81 |
Total Medicare Standardized Payment Amount |
17234.52 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
|
Number Of Drug Services |
|
Number Of Medicare Beneficiaries With Drug Services |
|
Total Drug Submitted ChargeAmount |
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Total Drug Medicare AllowedAmount |
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Total Drug Medicare PaymentAmount |
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Total Drug Medicare Standardized Payment Amount |
|
Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
|
Number Of Medical Services |
|
Number Of Medicare Beneficiaries With Medical Services |
|
Total Medical Submitted Charge Amount |
|
Total Medical Medicare Allowed Amount |
|
Total Medical Medicare Payment Amount |
|
Total Medical Medicare Standardized Payment Amount |
|
Average Age Of Beneficiaries |
63 |
Number Of Beneficiaries Age Less65 |
110 |
Number Of Beneficiaries Age 65 to 74 |
51 |
Number Of Beneficiaries Age 75 to 84 |
29 |
Number Of Beneficiaries Age Greater 84 |
16 |
Number Of Female Beneficiaries |
136 |
Number Of Male Beneficiaries |
70 |
Number Of Non Hispanic White Beneficiaries |
82 |
Number Of Black or African American Beneficiaries |
80 |
Number Of AsianPacific Islander Beneficiaries |
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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 |
36 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
170 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
17 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
23 |
Percent Of With Chronic Kidney Disease |
33 |
Percent Of With Chronic Obstructive Pulmonary Disease |
22 |
Percent Of With Depression |
43 |
Percent Of With Diabetes |
51 |
Percent Of With Hyperlipidemia |
47 |
Percent Of With Hypertension |
67 |
Percent Of With Ischemic Heart Disease |
36 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
15 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.8946 |