| National Provider Identifier [NPI]: | 1457672768 |
| Last Name Of The Provider | COGAN-DREW |
| First Name Of The Provider | THEA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 374 GRAND AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEW HAVEN |
| Zip Code Of The Provider | 065133733 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 175.5 |
| Number Of Medicare Beneficiaries | 120 |
| Total Submitted Charge Amount | 23283.2 |
| Total Medicare Allowed Amount | 8746.98 |
| Total Medicare Payment Amount | 7107.22 |
| Total Medicare Standardized Payment Amount | 7605.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 27.5 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 1607.2 |
| Total Drug Medicare AllowedAmount | 618.01 |
| Total Drug Medicare PaymentAmount | 599.07 |
| Total Drug Medicare Standardized Payment Amount | 599.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 148 |
| Number Of Medicare Beneficiaries With Medical Services | 120 |
| Total Medical Submitted Charge Amount | 21676 |
| Total Medical Medicare Allowed Amount | 8128.97 |
| Total Medical Medicare Payment Amount | 6508.15 |
| Total Medical Medicare Standardized Payment Amount | 7006.75 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 47 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 83 |
| Number Of Male Beneficiaries | 37 |
| Number Of Non Hispanic White Beneficiaries | 104 |
| 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 | 95 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1215 |