National Provider Identifier [NPI]: |
1124331533 |
Last Name Of The Provider |
MCFADDEN |
First Name Of The Provider |
GRANT |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
PA-C, MPAS |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
303 CATLIN ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
BUFFALO |
Zip Code Of The Provider |
553131947 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
17 |
Number Of Services |
317 |
Number Of Medicare Beneficiaries |
55 |
Total Submitted Charge Amount |
54604.6 |
Total Medicare Allowed Amount |
15788.39 |
Total Medicare Payment Amount |
12257.59 |
Total Medicare Standardized Payment Amount |
12811.6 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
225 |
Number Of Medicare Beneficiaries With Drug Services |
39 |
Total Drug Submitted ChargeAmount |
20850 |
Total Drug Medicare AllowedAmount |
8815.44 |
Total Drug Medicare PaymentAmount |
6843.62 |
Total Drug Medicare Standardized Payment Amount |
6843.62 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
14 |
Number Of Medical Services |
92 |
Number Of Medicare Beneficiaries With Medical Services |
55 |
Total Medical Submitted Charge Amount |
33754.6 |
Total Medical Medicare Allowed Amount |
6972.95 |
Total Medical Medicare Payment Amount |
5413.97 |
Total Medical Medicare Standardized Payment Amount |
5967.98 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
12 |
Number Of Beneficiaries Age 65 to 74 |
22 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
34 |
Number Of Male Beneficiaries |
21 |
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 |
38 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
17 |
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 |
20 |
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
42 |
Percent Of With Hyperlipidemia |
49 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1711 |