National Provider Identifier [NPI]: |
1215019724 |
Last Name Of The Provider |
SCOTT |
First Name Of The Provider |
MIA |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
DO |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
300 S JACKSON ST |
Street Address 2 Of The Provider |
#100 |
City Of The Provider |
DENVER |
Zip Code Of The Provider |
802093176 |
State Code Of The Provider |
CO |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
34 |
Number Of Services |
275 |
Number Of Medicare Beneficiaries |
63 |
Total Submitted Charge Amount |
44118.01 |
Total Medicare Allowed Amount |
24125.39 |
Total Medicare Payment Amount |
17166.89 |
Total Medicare Standardized Payment Amount |
18086.85 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
15 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
582.48 |
Total Drug Medicare AllowedAmount |
292.65 |
Total Drug Medicare PaymentAmount |
285.76 |
Total Drug Medicare Standardized Payment Amount |
285.76 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
28 |
Number Of Medical Services |
260 |
Number Of Medicare Beneficiaries With Medical Services |
63 |
Total Medical Submitted Charge Amount |
43535.53 |
Total Medical Medicare Allowed Amount |
23832.74 |
Total Medical Medicare Payment Amount |
16881.13 |
Total Medical Medicare Standardized Payment Amount |
17801.09 |
Average Age Of Beneficiaries |
63 |
Number Of Beneficiaries Age Less65 |
|
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 |
36 |
Number Of Male Beneficiaries |
27 |
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 |
|
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 |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
27 |
Percent Of With Diabetes |
24 |
Percent Of With Hyperlipidemia |
30 |
Percent Of With Hypertension |
43 |
Percent Of With Ischemic Heart Disease |
|
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7388 |