National Provider Identifier [NPI]: |
1245296839 |
Last Name Of The Provider |
SHULTMAN |
First Name Of The Provider |
DEBRA |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
ARNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
807 S ORLANDO AVE |
Street Address 2 Of The Provider |
SUITE C |
City Of The Provider |
WINTER PARK |
Zip Code Of The Provider |
327894870 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
8 |
Number Of Services |
219 |
Number Of Medicare Beneficiaries |
124 |
Total Submitted Charge Amount |
190744 |
Total Medicare Allowed Amount |
42391.45 |
Total Medicare Payment Amount |
32966.07 |
Total Medicare Standardized Payment Amount |
38855.88 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
8 |
Number Of Medical Services |
219 |
Number Of Medicare Beneficiaries With Medical Services |
124 |
Total Medical Submitted Charge Amount |
190744 |
Total Medical Medicare Allowed Amount |
42391.45 |
Total Medical Medicare Payment Amount |
32966.07 |
Total Medical Medicare Standardized Payment Amount |
38855.88 |
Average Age Of Beneficiaries |
61 |
Number Of Beneficiaries Age Less65 |
70 |
Number Of Beneficiaries Age 65 to 74 |
25 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
59 |
Number Of Male Beneficiaries |
65 |
Number Of Non Hispanic White Beneficiaries |
47 |
Number Of Black or African American Beneficiaries |
52 |
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 |
62 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
62 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
17 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
71 |
Percent Of With Chronic Kidney Disease |
75 |
Percent Of With Chronic Obstructive Pulmonary Disease |
26 |
Percent Of With Depression |
20 |
Percent Of With Diabetes |
61 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
63 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
25 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
15 |
Average HCC Risk Score Of Beneficiaries |
7.6958 |