National Provider Identifier [NPI]: |
1053398255 |
Last Name Of The Provider |
BORYCZKA |
First Name Of The Provider |
CHRISTINA |
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 |
2555 COUNTY ROAD E E |
Street Address 2 Of The Provider |
|
City Of The Provider |
WHITE BEAR LAKE |
Zip Code Of The Provider |
551104906 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
7 |
Number Of Services |
462 |
Number Of Medicare Beneficiaries |
188 |
Total Submitted Charge Amount |
64099 |
Total Medicare Allowed Amount |
30493.82 |
Total Medicare Payment Amount |
23267.56 |
Total Medicare Standardized Payment Amount |
23591.01 |
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 |
7 |
Number Of Medical Services |
462 |
Number Of Medicare Beneficiaries With Medical Services |
188 |
Total Medical Submitted Charge Amount |
64099 |
Total Medical Medicare Allowed Amount |
30493.82 |
Total Medical Medicare Payment Amount |
23267.56 |
Total Medical Medicare Standardized Payment Amount |
23591.01 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
35 |
Number Of Beneficiaries Age 65 to 74 |
54 |
Number Of Beneficiaries Age 75 to 84 |
60 |
Number Of Beneficiaries Age Greater 84 |
39 |
Number Of Female Beneficiaries |
121 |
Number Of Male Beneficiaries |
67 |
Number Of Non Hispanic White Beneficiaries |
173 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
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 |
152 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
36 |
Percent Of With Atrial Fibrillation |
15 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
7 |
Percent Of With Depression |
29 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
47 |
Percent Of With Hypertension |
66 |
Percent Of With Ischemic Heart Disease |
31 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
39 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1514 |