National Provider Identifier [NPI]: |
1841581865 |
Last Name Of The Provider |
DJERNES |
First Name Of The Provider |
KARISTEN |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6059 ARBURY WAY |
Street Address 2 Of The Provider |
STE 101 |
City Of The Provider |
OOLTEWAH |
Zip Code Of The Provider |
37363 |
State Code Of The Provider |
TN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
13 |
Number Of Services |
160 |
Number Of Medicare Beneficiaries |
51 |
Total Submitted Charge Amount |
17635 |
Total Medicare Allowed Amount |
6415.8 |
Total Medicare Payment Amount |
4753.41 |
Total Medicare Standardized Payment Amount |
5241.43 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
77 |
Number Of Medicare Beneficiaries With Drug Services |
18 |
Total Drug Submitted ChargeAmount |
1639 |
Total Drug Medicare AllowedAmount |
87.12 |
Total Drug Medicare PaymentAmount |
60.57 |
Total Drug Medicare Standardized Payment Amount |
60.57 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
8 |
Number Of Medical Services |
83 |
Number Of Medicare Beneficiaries With Medical Services |
51 |
Total Medical Submitted Charge Amount |
15996 |
Total Medical Medicare Allowed Amount |
6328.68 |
Total Medical Medicare Payment Amount |
4692.84 |
Total Medical Medicare Standardized Payment Amount |
5180.86 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
26 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
36 |
Number Of Male Beneficiaries |
15 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
24 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
22 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.064 |