National Provider Identifier [NPI]: |
1205913985 |
Last Name Of The Provider |
GERREK |
First Name Of The Provider |
MARLA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
RN,CNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6403 VALLEY PKWY |
Street Address 2 Of The Provider |
|
City Of The Provider |
NORTH ROYALTON |
Zip Code Of The Provider |
441335325 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
19 |
Number Of Services |
116 |
Number Of Medicare Beneficiaries |
73 |
Total Submitted Charge Amount |
6445.86 |
Total Medicare Allowed Amount |
4668.05 |
Total Medicare Payment Amount |
2830.49 |
Total Medicare Standardized Payment Amount |
3658.43 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
15 |
Number Of Medicare Beneficiaries With Drug Services |
14 |
Total Drug Submitted ChargeAmount |
653.86 |
Total Drug Medicare AllowedAmount |
491.26 |
Total Drug Medicare PaymentAmount |
481.4 |
Total Drug Medicare Standardized Payment Amount |
481.4 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
14 |
Number Of Medical Services |
101 |
Number Of Medicare Beneficiaries With Medical Services |
73 |
Total Medical Submitted Charge Amount |
5792 |
Total Medical Medicare Allowed Amount |
4176.79 |
Total Medical Medicare Payment Amount |
2349.09 |
Total Medical Medicare Standardized Payment Amount |
3177.03 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
40 |
Number Of Beneficiaries Age 75 to 84 |
15 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
57 |
Number Of Male Beneficiaries |
16 |
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 |
60 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
13 |
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 |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
16 |
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
49 |
Percent Of With Hypertension |
62 |
Percent Of With Ischemic Heart Disease |
23 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7949 |