National Provider Identifier [NPI]: |
1770810194 |
Last Name Of The Provider |
GREGORY |
First Name Of The Provider |
AMY |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
APN |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3000 N HALSTED ST |
Street Address 2 Of The Provider |
SUITE 723 |
City Of The Provider |
CHICAGO |
Zip Code Of The Provider |
606575188 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
27 |
Number Of Services |
465 |
Number Of Medicare Beneficiaries |
202 |
Total Submitted Charge Amount |
25417 |
Total Medicare Allowed Amount |
13399.84 |
Total Medicare Payment Amount |
9194.61 |
Total Medicare Standardized Payment Amount |
11059.16 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
156 |
Number Of Medicare Beneficiaries With Drug Services |
21 |
Total Drug Submitted ChargeAmount |
1673 |
Total Drug Medicare AllowedAmount |
184.43 |
Total Drug Medicare PaymentAmount |
157.59 |
Total Drug Medicare Standardized Payment Amount |
157.59 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
21 |
Number Of Medical Services |
309 |
Number Of Medicare Beneficiaries With Medical Services |
202 |
Total Medical Submitted Charge Amount |
23744 |
Total Medical Medicare Allowed Amount |
13215.41 |
Total Medical Medicare Payment Amount |
9037.02 |
Total Medical Medicare Standardized Payment Amount |
10901.57 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
17 |
Number Of Beneficiaries Age 65 to 74 |
87 |
Number Of Beneficiaries Age 75 to 84 |
62 |
Number Of Beneficiaries Age Greater 84 |
36 |
Number Of Female Beneficiaries |
125 |
Number Of Male Beneficiaries |
77 |
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 |
180 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
22 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
13 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
21 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
65 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
39 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.967 |