National Provider Identifier [NPI]: |
1225302763 |
Last Name Of The Provider |
WYCKOFF |
First Name Of The Provider |
DANA |
Middle Initial Of The Provider |
N |
Credentials Of The Provider |
NP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4809 ARGONNE ST |
Street Address 2 Of The Provider |
#150 |
City Of The Provider |
DENVER |
Zip Code Of The Provider |
802496834 |
State Code Of The Provider |
CO |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
120 |
Number Of Medicare Beneficiaries |
68 |
Total Submitted Charge Amount |
5735 |
Total Medicare Allowed Amount |
4197.76 |
Total Medicare Payment Amount |
3123.18 |
Total Medicare Standardized Payment Amount |
3588.02 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
31 |
Number Of Medicare Beneficiaries With Drug Services |
30 |
Total Drug Submitted ChargeAmount |
625 |
Total Drug Medicare AllowedAmount |
454.55 |
Total Drug Medicare PaymentAmount |
445.44 |
Total Drug Medicare Standardized Payment Amount |
445.44 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
10 |
Number Of Medical Services |
89 |
Number Of Medicare Beneficiaries With Medical Services |
68 |
Total Medical Submitted Charge Amount |
5110 |
Total Medical Medicare Allowed Amount |
3743.21 |
Total Medical Medicare Payment Amount |
2677.74 |
Total Medical Medicare Standardized Payment Amount |
3142.58 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
42 |
Number Of Beneficiaries Age 75 to 84 |
15 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
50 |
Number Of Male Beneficiaries |
18 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
16 |
Percent Of With Diabetes |
18 |
Percent Of With Hyperlipidemia |
34 |
Percent Of With Hypertension |
46 |
Percent Of With Ischemic Heart Disease |
21 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
31 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
0 |
Average HCC Risk Score Of Beneficiaries |
0.8588 |