National Provider Identifier [NPI]: |
1912085879 |
Last Name Of The Provider |
SIMMONS |
First Name Of The Provider |
IDELLA |
Middle Initial Of The Provider |
N |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
950 N ALABAMA ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
INDIANAPOLIS |
Zip Code Of The Provider |
462023350 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
29 |
Number Of Services |
560 |
Number Of Medicare Beneficiaries |
113 |
Total Submitted Charge Amount |
43966 |
Total Medicare Allowed Amount |
32464.41 |
Total Medicare Payment Amount |
21503.95 |
Total Medicare Standardized Payment Amount |
22861.75 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
29 |
Number Of Medicare Beneficiaries With Drug Services |
26 |
Total Drug Submitted ChargeAmount |
1387 |
Total Drug Medicare AllowedAmount |
667.32 |
Total Drug Medicare PaymentAmount |
653.98 |
Total Drug Medicare Standardized Payment Amount |
653.98 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
26 |
Number Of Medical Services |
531 |
Number Of Medicare Beneficiaries With Medical Services |
113 |
Total Medical Submitted Charge Amount |
42579 |
Total Medical Medicare Allowed Amount |
31797.09 |
Total Medical Medicare Payment Amount |
20849.97 |
Total Medical Medicare Standardized Payment Amount |
22207.77 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
28 |
Number Of Beneficiaries Age 65 to 74 |
46 |
Number Of Beneficiaries Age 75 to 84 |
22 |
Number Of Beneficiaries Age Greater 84 |
17 |
Number Of Female Beneficiaries |
78 |
Number Of Male Beneficiaries |
35 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
63 |
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 |
77 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
36 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
30 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
47 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
19 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
23 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.247 |