National Provider Identifier [NPI]: |
1467443036 |
Last Name Of The Provider |
PENLAND |
First Name Of The Provider |
KIMBERLY |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
FNP-BC, P.H.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1234 E. DUPONT RD. |
Street Address 2 Of The Provider |
SUITE 6 |
City Of The Provider |
FORT WAYNE |
Zip Code Of The Provider |
468251545 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
18 |
Number Of Services |
132 |
Number Of Medicare Beneficiaries |
66 |
Total Submitted Charge Amount |
11238 |
Total Medicare Allowed Amount |
8362.02 |
Total Medicare Payment Amount |
5649.06 |
Total Medicare Standardized Payment Amount |
7287.11 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
15 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
749 |
Total Drug Medicare AllowedAmount |
656.03 |
Total Drug Medicare PaymentAmount |
642.87 |
Total Drug Medicare Standardized Payment Amount |
642.87 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
15 |
Number Of Medical Services |
117 |
Number Of Medicare Beneficiaries With Medical Services |
66 |
Total Medical Submitted Charge Amount |
10489 |
Total Medical Medicare Allowed Amount |
7705.99 |
Total Medical Medicare Payment Amount |
5006.19 |
Total Medical Medicare Standardized Payment Amount |
6644.24 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
16 |
Number Of Beneficiaries Age 65 to 74 |
37 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
49 |
Number Of Male Beneficiaries |
17 |
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 |
51 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
15 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
45 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
53 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
18 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9971 |