National Provider Identifier [NPI]: |
1326391509 |
Last Name Of The Provider |
CORCORAN |
First Name Of The Provider |
KELLY |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6934 AVIATION BLVD |
Street Address 2 Of The Provider |
STE. B |
City Of The Provider |
GLEN BURNIE |
Zip Code Of The Provider |
210612593 |
State Code Of The Provider |
MD |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
16 |
Number Of Services |
850 |
Number Of Medicare Beneficiaries |
472 |
Total Submitted Charge Amount |
253044 |
Total Medicare Allowed Amount |
76622.1 |
Total Medicare Payment Amount |
59436.9 |
Total Medicare Standardized Payment Amount |
66750.52 |
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 |
16 |
Number Of Medical Services |
850 |
Number Of Medicare Beneficiaries With Medical Services |
472 |
Total Medical Submitted Charge Amount |
253044 |
Total Medical Medicare Allowed Amount |
76622.1 |
Total Medical Medicare Payment Amount |
59436.9 |
Total Medical Medicare Standardized Payment Amount |
66750.52 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
62 |
Number Of Beneficiaries Age 65 to 74 |
199 |
Number Of Beneficiaries Age 75 to 84 |
133 |
Number Of Beneficiaries Age Greater 84 |
78 |
Number Of Female Beneficiaries |
274 |
Number Of Male Beneficiaries |
198 |
Number Of Non Hispanic White Beneficiaries |
374 |
Number Of Black or African American Beneficiaries |
80 |
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 |
410 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
62 |
Percent Of With Atrial Fibrillation |
25 |
Percent Of With Alzheimers Disease or Dementia |
17 |
Percent Of With Asthma |
18 |
Percent Of With Cancer |
18 |
Percent Of With Heart Failure |
31 |
Percent Of With Chronic Kidney Disease |
39 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
39 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
71 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
49 |
Percent Of With Osteoporosis |
16 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
62 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
17 |
Average HCC Risk Score Of Beneficiaries |
1.8333 |