National Provider Identifier [NPI]: |
1184907099 |
Last Name Of The Provider |
BLEDSOE |
First Name Of The Provider |
BRANDEN |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
APRN |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
311 E CLIFTY DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
MADISON |
Zip Code Of The Provider |
472504621 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
97 |
Number Of Services |
1342 |
Number Of Medicare Beneficiaries |
204 |
Total Submitted Charge Amount |
51458 |
Total Medicare Allowed Amount |
31693.05 |
Total Medicare Payment Amount |
25128.97 |
Total Medicare Standardized Payment Amount |
30136.66 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
12 |
Number Of Drug Services |
383 |
Number Of Medicare Beneficiaries With Drug Services |
53 |
Total Drug Submitted ChargeAmount |
2700 |
Total Drug Medicare AllowedAmount |
247.98 |
Total Drug Medicare PaymentAmount |
200.53 |
Total Drug Medicare Standardized Payment Amount |
200.53 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
85 |
Number Of Medical Services |
959 |
Number Of Medicare Beneficiaries With Medical Services |
204 |
Total Medical Submitted Charge Amount |
48758 |
Total Medical Medicare Allowed Amount |
31445.07 |
Total Medical Medicare Payment Amount |
24928.44 |
Total Medical Medicare Standardized Payment Amount |
29936.13 |
Average Age Of Beneficiaries |
66 |
Number Of Beneficiaries Age Less65 |
71 |
Number Of Beneficiaries Age 65 to 74 |
81 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
136 |
Number Of Male Beneficiaries |
68 |
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 |
127 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
77 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
28 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
42 |
Percent Of With Hypertension |
58 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0961 |