National Provider Identifier [NPI]: |
1598985178 |
Last Name Of The Provider |
BROOME |
First Name Of The Provider |
LISA |
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 |
16 N LA PLATA CT |
Street Address 2 Of The Provider |
|
City Of The Provider |
LA PLATA |
Zip Code Of The Provider |
206464283 |
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 |
183 |
Number Of Medicare Beneficiaries |
54 |
Total Submitted Charge Amount |
27625 |
Total Medicare Allowed Amount |
10885.67 |
Total Medicare Payment Amount |
8460.52 |
Total Medicare Standardized Payment Amount |
9433.52 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
74 |
Number Of Medicare Beneficiaries With Drug Services |
20 |
Total Drug Submitted ChargeAmount |
4610 |
Total Drug Medicare AllowedAmount |
1973.9 |
Total Drug Medicare PaymentAmount |
1547.43 |
Total Drug Medicare Standardized Payment Amount |
1547.43 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
14 |
Number Of Medical Services |
109 |
Number Of Medicare Beneficiaries With Medical Services |
54 |
Total Medical Submitted Charge Amount |
23015 |
Total Medical Medicare Allowed Amount |
8911.77 |
Total Medical Medicare Payment Amount |
6913.09 |
Total Medical Medicare Standardized Payment Amount |
7886.09 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
29 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
39 |
Number Of Male Beneficiaries |
15 |
Number Of Non Hispanic White Beneficiaries |
42 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
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 |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
39 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
72 |
Percent Of With Ischemic Heart Disease |
24 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
65 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.3497 |