National Provider Identifier [NPI]: |
1306834791 |
Last Name Of The Provider |
MENTON |
First Name Of The Provider |
ELIZABETH |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
|
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
313 E SAVANNAH RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
LEWES |
Zip Code Of The Provider |
199581130 |
State Code Of The Provider |
DE |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
75 |
Number Of Services |
311 |
Number Of Medicare Beneficiaries |
306 |
Total Submitted Charge Amount |
223386.2 |
Total Medicare Allowed Amount |
41227.99 |
Total Medicare Payment Amount |
32142.95 |
Total Medicare Standardized Payment Amount |
31599.62 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
75 |
Number Of Medical Services |
311 |
Number Of Medicare Beneficiaries With Medical Services |
306 |
Total Medical Submitted Charge Amount |
223386.2 |
Total Medical Medicare Allowed Amount |
41227.99 |
Total Medical Medicare Payment Amount |
32142.95 |
Total Medical Medicare Standardized Payment Amount |
31599.62 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
47 |
Number Of Beneficiaries Age 65 to 74 |
150 |
Number Of Beneficiaries Age 75 to 84 |
86 |
Number Of Beneficiaries Age Greater 84 |
23 |
Number Of Female Beneficiaries |
169 |
Number Of Male Beneficiaries |
137 |
Number Of Non Hispanic White Beneficiaries |
250 |
Number Of Black or African American Beneficiaries |
45 |
Number Of AsianPacific Islander Beneficiaries |
|
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 |
254 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
52 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
20 |
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
29 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
34 |
Percent Of With Hyperlipidemia |
73 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
42 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.3403 |