National Provider Identifier [NPI]: |
1568694685 |
Last Name Of The Provider |
QUIRION |
First Name Of The Provider |
EVA |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
NP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
900 BROADWAY |
Street Address 2 Of The Provider |
|
City Of The Provider |
BANGOR |
Zip Code Of The Provider |
044011900 |
State Code Of The Provider |
ME |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
24 |
Number Of Services |
385 |
Number Of Medicare Beneficiaries |
130 |
Total Submitted Charge Amount |
48862 |
Total Medicare Allowed Amount |
26018.58 |
Total Medicare Payment Amount |
19977.52 |
Total Medicare Standardized Payment Amount |
25067.06 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
54 |
Number Of Medicare Beneficiaries With Drug Services |
39 |
Total Drug Submitted ChargeAmount |
607 |
Total Drug Medicare AllowedAmount |
397.67 |
Total Drug Medicare PaymentAmount |
340.32 |
Total Drug Medicare Standardized Payment Amount |
340.32 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
17 |
Number Of Medical Services |
331 |
Number Of Medicare Beneficiaries With Medical Services |
130 |
Total Medical Submitted Charge Amount |
48255 |
Total Medical Medicare Allowed Amount |
25620.91 |
Total Medical Medicare Payment Amount |
19637.2 |
Total Medical Medicare Standardized Payment Amount |
24726.74 |
Average Age Of Beneficiaries |
65 |
Number Of Beneficiaries Age Less65 |
60 |
Number Of Beneficiaries Age 65 to 74 |
40 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
80 |
Number Of Male Beneficiaries |
50 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
69 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
61 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
27 |
Percent Of With Depression |
50 |
Percent Of With Diabetes |
25 |
Percent Of With Hyperlipidemia |
49 |
Percent Of With Hypertension |
55 |
Percent Of With Ischemic Heart Disease |
31 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
55 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2331 |