National Provider Identifier [NPI]: |
1245311570 |
Last Name Of The Provider |
ROTH |
First Name Of The Provider |
CHERYL |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3907 6TH AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
KEARNEY |
Zip Code Of The Provider |
688453392 |
State Code Of The Provider |
NE |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
17 |
Number Of Services |
512 |
Number Of Medicare Beneficiaries |
438 |
Total Submitted Charge Amount |
153282 |
Total Medicare Allowed Amount |
71872.74 |
Total Medicare Payment Amount |
53122.23 |
Total Medicare Standardized Payment Amount |
56653.19 |
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 |
17 |
Number Of Medical Services |
512 |
Number Of Medicare Beneficiaries With Medical Services |
438 |
Total Medical Submitted Charge Amount |
153282 |
Total Medical Medicare Allowed Amount |
71872.74 |
Total Medical Medicare Payment Amount |
53122.23 |
Total Medical Medicare Standardized Payment Amount |
56653.19 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
75 |
Number Of Beneficiaries Age 65 to 74 |
114 |
Number Of Beneficiaries Age 75 to 84 |
147 |
Number Of Beneficiaries Age Greater 84 |
102 |
Number Of Female Beneficiaries |
238 |
Number Of Male Beneficiaries |
200 |
Number Of Non Hispanic White Beneficiaries |
422 |
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 |
338 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
100 |
Percent Of With Atrial Fibrillation |
30 |
Percent Of With Alzheimers Disease or Dementia |
24 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
38 |
Percent Of With Chronic Kidney Disease |
38 |
Percent Of With Chronic Obstructive Pulmonary Disease |
33 |
Percent Of With Depression |
47 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
57 |
Percent Of With Osteoporosis |
16 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
51 |
Percent Of With Schizophrenia Other PsychoticDisorders |
13 |
Percent Of With Stroke |
12 |
Average HCC Risk Score Of Beneficiaries |
1.7997 |