Medicare Facts for Jacqueline D. McCullough, LBSW


National Provider Identifier [NPI]: 1356312771
Last Name Of The Provider MCCULLOUGH
First Name Of The Provider JACQUELINE
Middle Initial Of The Provider M
Credentials Of The Provider MS RD CDN
Gender Of The Provider F
Entity Type Of The Provider I
Street Address 1 Of The Provider 2200 WHITNEY AVE
Street Address 2 Of The Provider SUITE 180
City Of The Provider HAMDEN
Zip Code Of The Provider 065183691
State Code Of The Provider CT
Country Code Of The Provider US
Provider Type Of The Provider Registered Dietician/Nutrition Professional
Medicare Participation Indicator Y
Number Of HCPCS 2
Number Of Services 115
Number Of Medicare Beneficiaries 18
Total Submitted Charge Amount 7910
Total Medicare Allowed Amount 3451.17
Total Medicare Payment Amount 3382.24
Total Medicare Standardized Payment Amount 1799.43
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 2
Number Of Medical Services 115
Number Of Medicare Beneficiaries With Medical Services 18
Total Medical Submitted Charge Amount 7910
Total Medical Medicare Allowed Amount 3451.17
Total Medical Medicare Payment Amount 3382.24
Total Medical Medicare Standardized Payment Amount 1799.43
Average Age Of Beneficiaries 66
Number Of Beneficiaries Age Less65
Number Of Beneficiaries Age 65 to 74
Number Of Beneficiaries Age 75 to 84
Number Of Beneficiaries Age Greater 84
Number Of Female Beneficiaries
Number Of Male Beneficiaries
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
Number Of Beneficiaries With Medicare Medicaid Entitlement
Percent Of With Atrial Fibrillation
Percent Of With Alzheimers Disease or Dementia 0
Percent Of With Asthma
Percent Of With Cancer
Percent Of With Heart Failure
Percent Of With Chronic Kidney Disease
Percent Of With Chronic Obstructive Pulmonary Disease
Percent Of With Depression
Percent Of With Diabetes 75
Percent Of With Hyperlipidemia 75
Percent Of With Hypertension 75
Percent Of With Ischemic Heart Disease
Percent Of With Osteoporosis
Percent Of With Rheumatoid Arthritis Osteoarthritis
Percent Of With Schizophrenia Other PsychoticDisorders 0
Percent Of With Stroke 0
Average HCC Risk Score Of Beneficiaries 1.7034

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