National Provider Identifier [NPI]: |
1336445956 |
Last Name Of The Provider |
NISAN |
First Name Of The Provider |
ABIGAIL |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
120 E HARRIS AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
SAN ANGELO |
Zip Code Of The Provider |
769035904 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
20 |
Number Of Services |
765 |
Number Of Medicare Beneficiaries |
321 |
Total Submitted Charge Amount |
193278 |
Total Medicare Allowed Amount |
80948.88 |
Total Medicare Payment Amount |
62567.53 |
Total Medicare Standardized Payment Amount |
60734.52 |
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 |
20 |
Number Of Medical Services |
765 |
Number Of Medicare Beneficiaries With Medical Services |
321 |
Total Medical Submitted Charge Amount |
193278 |
Total Medical Medicare Allowed Amount |
80948.88 |
Total Medical Medicare Payment Amount |
62567.53 |
Total Medical Medicare Standardized Payment Amount |
60734.52 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
69 |
Number Of Beneficiaries Age 65 to 74 |
95 |
Number Of Beneficiaries Age 75 to 84 |
85 |
Number Of Beneficiaries Age Greater 84 |
72 |
Number Of Female Beneficiaries |
155 |
Number Of Male Beneficiaries |
166 |
Number Of Non Hispanic White Beneficiaries |
259 |
Number Of Black or African American Beneficiaries |
46 |
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 |
227 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
94 |
Percent Of With Atrial Fibrillation |
21 |
Percent Of With Alzheimers Disease or Dementia |
29 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
40 |
Percent Of With Chronic Kidney Disease |
53 |
Percent Of With Chronic Obstructive Pulmonary Disease |
32 |
Percent Of With Depression |
43 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
65 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
57 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
17 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
2.0919 |