National Provider Identifier [NPI]: |
1144209354 |
Last Name Of The Provider |
BESSONETT |
First Name Of The Provider |
PAULA |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
222 E. FIFTH STREET |
Street Address 2 Of The Provider |
|
City Of The Provider |
TYLER |
Zip Code Of The Provider |
75701 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
26 |
Number Of Services |
759 |
Number Of Medicare Beneficiaries |
131 |
Total Submitted Charge Amount |
64115 |
Total Medicare Allowed Amount |
49647.77 |
Total Medicare Payment Amount |
34809.43 |
Total Medicare Standardized Payment Amount |
37502.83 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
143 |
Number Of Medicare Beneficiaries With Drug Services |
45 |
Total Drug Submitted ChargeAmount |
1970 |
Total Drug Medicare AllowedAmount |
1117.56 |
Total Drug Medicare PaymentAmount |
1059.1 |
Total Drug Medicare Standardized Payment Amount |
1059.1 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
18 |
Number Of Medical Services |
616 |
Number Of Medicare Beneficiaries With Medical Services |
131 |
Total Medical Submitted Charge Amount |
62145 |
Total Medical Medicare Allowed Amount |
48530.21 |
Total Medical Medicare Payment Amount |
33750.33 |
Total Medical Medicare Standardized Payment Amount |
36443.73 |
Average Age Of Beneficiaries |
64 |
Number Of Beneficiaries Age Less65 |
60 |
Number Of Beneficiaries Age 65 to 74 |
46 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
73 |
Number Of Male Beneficiaries |
58 |
Number Of Non Hispanic White Beneficiaries |
102 |
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 |
88 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
43 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
13 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
11 |
Percent Of With Chronic Obstructive Pulmonary Disease |
23 |
Percent Of With Depression |
49 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
37 |
Percent Of With Hypertension |
65 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
51 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2309 |