National Provider Identifier [NPI]: |
1346264124 |
Last Name Of The Provider |
KOWALSKI |
First Name Of The Provider |
LISE |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
130 FISHER RD |
Street Address 2 Of The Provider |
SUITE 3-1 |
City Of The Provider |
BERLIN |
Zip Code Of The Provider |
056029516 |
State Code Of The Provider |
VT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
46 |
Number Of Services |
1221 |
Number Of Medicare Beneficiaries |
360 |
Total Submitted Charge Amount |
275187.11 |
Total Medicare Allowed Amount |
93736.14 |
Total Medicare Payment Amount |
68423.5 |
Total Medicare Standardized Payment Amount |
69068.33 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
107 |
Number Of Medicare Beneficiaries With Drug Services |
89 |
Total Drug Submitted ChargeAmount |
3273.11 |
Total Drug Medicare AllowedAmount |
1283.88 |
Total Drug Medicare PaymentAmount |
1205.58 |
Total Drug Medicare Standardized Payment Amount |
1205.58 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
37 |
Number Of Medical Services |
1114 |
Number Of Medicare Beneficiaries With Medical Services |
359 |
Total Medical Submitted Charge Amount |
271914 |
Total Medical Medicare Allowed Amount |
92452.26 |
Total Medical Medicare Payment Amount |
67217.92 |
Total Medical Medicare Standardized Payment Amount |
67862.75 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
49 |
Number Of Beneficiaries Age 65 to 74 |
142 |
Number Of Beneficiaries Age 75 to 84 |
107 |
Number Of Beneficiaries Age Greater 84 |
62 |
Number Of Female Beneficiaries |
282 |
Number Of Male Beneficiaries |
78 |
Number Of Non Hispanic White Beneficiaries |
344 |
Number Of Black or African American Beneficiaries |
0 |
Number Of AsianPacific Islander Beneficiaries |
0 |
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 |
276 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
84 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
11 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
20 |
Percent Of With Diabetes |
25 |
Percent Of With Hyperlipidemia |
37 |
Percent Of With Hypertension |
54 |
Percent Of With Ischemic Heart Disease |
20 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
0.9382 |