National Provider Identifier [NPI]: |
1558514711 |
Last Name Of The Provider |
SLAVINA |
First Name Of The Provider |
IRINA |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1601 WATSON BLVD. |
Street Address 2 Of The Provider |
|
City Of The Provider |
WARNER ROBINS |
Zip Code Of The Provider |
31093 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
12 |
Number Of Services |
1316 |
Number Of Medicare Beneficiaries |
427 |
Total Submitted Charge Amount |
260187 |
Total Medicare Allowed Amount |
133198.12 |
Total Medicare Payment Amount |
101130.19 |
Total Medicare Standardized Payment Amount |
106254.07 |
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 |
12 |
Number Of Medical Services |
1316 |
Number Of Medicare Beneficiaries With Medical Services |
427 |
Total Medical Submitted Charge Amount |
260187 |
Total Medical Medicare Allowed Amount |
133198.12 |
Total Medical Medicare Payment Amount |
101130.19 |
Total Medical Medicare Standardized Payment Amount |
106254.07 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
94 |
Number Of Beneficiaries Age 65 to 74 |
130 |
Number Of Beneficiaries Age 75 to 84 |
129 |
Number Of Beneficiaries Age Greater 84 |
74 |
Number Of Female Beneficiaries |
229 |
Number Of Male Beneficiaries |
198 |
Number Of Non Hispanic White Beneficiaries |
319 |
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 |
321 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
106 |
Percent Of With Atrial Fibrillation |
21 |
Percent Of With Alzheimers Disease or Dementia |
25 |
Percent Of With Asthma |
15 |
Percent Of With Cancer |
17 |
Percent Of With Heart Failure |
49 |
Percent Of With Chronic Kidney Disease |
64 |
Percent Of With Chronic Obstructive Pulmonary Disease |
52 |
Percent Of With Depression |
35 |
Percent Of With Diabetes |
54 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
68 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
13 |
Average HCC Risk Score Of Beneficiaries |
2.5963 |