National Provider Identifier [NPI]: |
1255644506 |
Last Name Of The Provider |
MELVIN |
First Name Of The Provider |
ANNE |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2025 E NEWPORT AVE |
Street Address 2 Of The Provider |
S217 |
City Of The Provider |
MILWAUKEE |
Zip Code Of The Provider |
532112906 |
State Code Of The Provider |
WI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
25 |
Number Of Services |
1052 |
Number Of Medicare Beneficiaries |
384 |
Total Submitted Charge Amount |
166556 |
Total Medicare Allowed Amount |
73674.68 |
Total Medicare Payment Amount |
53815.14 |
Total Medicare Standardized Payment Amount |
66709.89 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
59 |
Number Of Medicare Beneficiaries With Drug Services |
50 |
Total Drug Submitted ChargeAmount |
1526 |
Total Drug Medicare AllowedAmount |
1011.88 |
Total Drug Medicare PaymentAmount |
959.27 |
Total Drug Medicare Standardized Payment Amount |
959.27 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
20 |
Number Of Medical Services |
993 |
Number Of Medicare Beneficiaries With Medical Services |
384 |
Total Medical Submitted Charge Amount |
165030 |
Total Medical Medicare Allowed Amount |
72662.8 |
Total Medical Medicare Payment Amount |
52855.87 |
Total Medical Medicare Standardized Payment Amount |
65750.62 |
Average Age Of Beneficiaries |
78 |
Number Of Beneficiaries Age Less65 |
21 |
Number Of Beneficiaries Age 65 to 74 |
104 |
Number Of Beneficiaries Age 75 to 84 |
150 |
Number Of Beneficiaries Age Greater 84 |
109 |
Number Of Female Beneficiaries |
266 |
Number Of Male Beneficiaries |
118 |
Number Of Non Hispanic White Beneficiaries |
364 |
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 |
350 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
34 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
21 |
Percent Of With Diabetes |
24 |
Percent Of With Hyperlipidemia |
68 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.2321 |