National Provider Identifier [NPI]: |
1922027341 |
Last Name Of The Provider |
JOCELYN |
First Name Of The Provider |
JUDIVE |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
D.O |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
10762 SE US HIGHWAY 441 |
Street Address 2 Of The Provider |
|
City Of The Provider |
BELLEVIEW |
Zip Code Of The Provider |
344203805 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
6 |
Number Of Services |
96 |
Number Of Medicare Beneficiaries |
72 |
Total Submitted Charge Amount |
14360 |
Total Medicare Allowed Amount |
5871.19 |
Total Medicare Payment Amount |
4099.69 |
Total Medicare Standardized Payment Amount |
4067.9 |
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 |
6 |
Number Of Medical Services |
96 |
Number Of Medicare Beneficiaries With Medical Services |
72 |
Total Medical Submitted Charge Amount |
14360 |
Total Medical Medicare Allowed Amount |
5871.19 |
Total Medical Medicare Payment Amount |
4099.69 |
Total Medical Medicare Standardized Payment Amount |
4067.9 |
Average Age Of Beneficiaries |
59 |
Number Of Beneficiaries Age Less65 |
50 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
42 |
Number Of Male Beneficiaries |
30 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
52 |
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 |
19 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
53 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
22 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
24 |
Percent Of With Chronic Kidney Disease |
44 |
Percent Of With Chronic Obstructive Pulmonary Disease |
21 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
49 |
Percent Of With Hyperlipidemia |
71 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.6482 |