National Provider Identifier [NPI]: |
1083637409 |
Last Name Of The Provider |
CHELOHA |
First Name Of The Provider |
MICHELLE |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3911 AVENUE B |
Street Address 2 Of The Provider |
SUITE 1100 |
City Of The Provider |
SCOTTSBLUFF |
Zip Code Of The Provider |
693614617 |
State Code Of The Provider |
NE |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
146 |
Number Of Services |
6767 |
Number Of Medicare Beneficiaries |
525 |
Total Submitted Charge Amount |
464836 |
Total Medicare Allowed Amount |
215463.57 |
Total Medicare Payment Amount |
164345.82 |
Total Medicare Standardized Payment Amount |
174526.86 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
18 |
Number Of Drug Services |
3203 |
Number Of Medicare Beneficiaries With Drug Services |
148 |
Total Drug Submitted ChargeAmount |
68841 |
Total Drug Medicare AllowedAmount |
31047.59 |
Total Drug Medicare PaymentAmount |
24615.37 |
Total Drug Medicare Standardized Payment Amount |
24615.37 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
128 |
Number Of Medical Services |
3564 |
Number Of Medicare Beneficiaries With Medical Services |
525 |
Total Medical Submitted Charge Amount |
395995 |
Total Medical Medicare Allowed Amount |
184415.98 |
Total Medical Medicare Payment Amount |
139730.45 |
Total Medical Medicare Standardized Payment Amount |
149911.49 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
68 |
Number Of Beneficiaries Age 65 to 74 |
230 |
Number Of Beneficiaries Age 75 to 84 |
161 |
Number Of Beneficiaries Age Greater 84 |
66 |
Number Of Female Beneficiaries |
428 |
Number Of Male Beneficiaries |
97 |
Number Of Non Hispanic White Beneficiaries |
481 |
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 |
436 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
89 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
20 |
Percent Of With Hyperlipidemia |
39 |
Percent Of With Hypertension |
60 |
Percent Of With Ischemic Heart Disease |
23 |
Percent Of With Osteoporosis |
27 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0575 |