National Provider Identifier [NPI]: |
1083645733 |
Last Name Of The Provider |
ESTRELLADO |
First Name Of The Provider |
TRACY |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
840 E HILL AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
MOSES LAKE |
Zip Code Of The Provider |
988372238 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
40 |
Number Of Services |
3510 |
Number Of Medicare Beneficiaries |
370 |
Total Submitted Charge Amount |
366778.58 |
Total Medicare Allowed Amount |
118434.59 |
Total Medicare Payment Amount |
84253.76 |
Total Medicare Standardized Payment Amount |
94562.19 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
2309 |
Number Of Medicare Beneficiaries With Drug Services |
198 |
Total Drug Submitted ChargeAmount |
71368.08 |
Total Drug Medicare AllowedAmount |
20124.09 |
Total Drug Medicare PaymentAmount |
14347.03 |
Total Drug Medicare Standardized Payment Amount |
14347.03 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
35 |
Number Of Medical Services |
1201 |
Number Of Medicare Beneficiaries With Medical Services |
370 |
Total Medical Submitted Charge Amount |
295410.5 |
Total Medical Medicare Allowed Amount |
98310.5 |
Total Medical Medicare Payment Amount |
69906.73 |
Total Medical Medicare Standardized Payment Amount |
80215.16 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
63 |
Number Of Beneficiaries Age 65 to 74 |
155 |
Number Of Beneficiaries Age 75 to 84 |
100 |
Number Of Beneficiaries Age Greater 84 |
52 |
Number Of Female Beneficiaries |
241 |
Number Of Male Beneficiaries |
129 |
Number Of Non Hispanic White Beneficiaries |
311 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
41 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
281 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
89 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
39 |
Percent Of With Hyperlipidemia |
58 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
31 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0877 |