National Provider Identifier [NPI]: |
1417987579 |
Last Name Of The Provider |
ICE |
First Name Of The Provider |
MELANIE |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
DO |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1055 ANDREW DR |
Street Address 2 Of The Provider |
SUITE B |
City Of The Provider |
WEST CHESTER |
Zip Code Of The Provider |
193803446 |
State Code Of The Provider |
PA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
37 |
Number Of Services |
574 |
Number Of Medicare Beneficiaries |
179 |
Total Submitted Charge Amount |
81504 |
Total Medicare Allowed Amount |
43073.59 |
Total Medicare Payment Amount |
33834.96 |
Total Medicare Standardized Payment Amount |
32296.64 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
13 |
Number Of Drug Services |
109 |
Number Of Medicare Beneficiaries With Drug Services |
69 |
Total Drug Submitted ChargeAmount |
5107 |
Total Drug Medicare AllowedAmount |
2670.26 |
Total Drug Medicare PaymentAmount |
2572.4 |
Total Drug Medicare Standardized Payment Amount |
2572.4 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
24 |
Number Of Medical Services |
465 |
Number Of Medicare Beneficiaries With Medical Services |
177 |
Total Medical Submitted Charge Amount |
76397 |
Total Medical Medicare Allowed Amount |
40403.33 |
Total Medical Medicare Payment Amount |
31262.56 |
Total Medical Medicare Standardized Payment Amount |
29724.24 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
106 |
Number Of Beneficiaries Age 75 to 84 |
36 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
129 |
Number Of Male Beneficiaries |
50 |
Number Of Non Hispanic White Beneficiaries |
149 |
Number Of Black or African American Beneficiaries |
13 |
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 |
166 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
13 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
0 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
8 |
Percent Of With Chronic Kidney Disease |
9 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
12 |
Percent Of With Diabetes |
20 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
51 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7763 |