National Provider Identifier [NPI]: |
1013252659 |
Last Name Of The Provider |
OSBORNE |
First Name Of The Provider |
JOVONNE |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
CRNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1016 S SALISBURY BLVD |
Street Address 2 Of The Provider |
CVS MINUTE CLINIC |
City Of The Provider |
SALISBURY |
Zip Code Of The Provider |
218016361 |
State Code Of The Provider |
MD |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
19 |
Number Of Services |
265 |
Number Of Medicare Beneficiaries |
137 |
Total Submitted Charge Amount |
7835.87 |
Total Medicare Allowed Amount |
7368.72 |
Total Medicare Payment Amount |
6627.85 |
Total Medicare Standardized Payment Amount |
7400.43 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
113 |
Number Of Medicare Beneficiaries With Drug Services |
110 |
Total Drug Submitted ChargeAmount |
2474.87 |
Total Drug Medicare AllowedAmount |
2415.59 |
Total Drug Medicare PaymentAmount |
2367.26 |
Total Drug Medicare Standardized Payment Amount |
2367.26 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
11 |
Number Of Medical Services |
152 |
Number Of Medicare Beneficiaries With Medical Services |
137 |
Total Medical Submitted Charge Amount |
5361 |
Total Medical Medicare Allowed Amount |
4953.13 |
Total Medical Medicare Payment Amount |
4260.59 |
Total Medical Medicare Standardized Payment Amount |
5033.17 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
80 |
Number Of Beneficiaries Age 75 to 84 |
35 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
80 |
Number Of Male Beneficiaries |
57 |
Number Of Non Hispanic White Beneficiaries |
120 |
Number Of Black or African American Beneficiaries |
|
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 |
123 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
14 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
59 |
Percent Of With Hypertension |
61 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
27 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8272 |