National Provider Identifier [NPI]: |
1821259995 |
Last Name Of The Provider |
PRICKETT |
First Name Of The Provider |
MICHELLE |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
675 N SAINT CLAIR ST |
Street Address 2 Of The Provider |
SUITE: 18-250 |
City Of The Provider |
CHICAGO |
Zip Code Of The Provider |
606115975 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Pulmonary Disease |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
29 |
Number Of Services |
902 |
Number Of Medicare Beneficiaries |
322 |
Total Submitted Charge Amount |
349764 |
Total Medicare Allowed Amount |
119479.49 |
Total Medicare Payment Amount |
92759.72 |
Total Medicare Standardized Payment Amount |
86814.98 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
12 |
Number Of Medicare Beneficiaries With Drug Services |
12 |
Total Drug Submitted ChargeAmount |
320 |
Total Drug Medicare AllowedAmount |
172.4 |
Total Drug Medicare PaymentAmount |
168.94 |
Total Drug Medicare Standardized Payment Amount |
168.94 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
26 |
Number Of Medical Services |
890 |
Number Of Medicare Beneficiaries With Medical Services |
322 |
Total Medical Submitted Charge Amount |
349444 |
Total Medical Medicare Allowed Amount |
119307.09 |
Total Medical Medicare Payment Amount |
92590.78 |
Total Medical Medicare Standardized Payment Amount |
86646.04 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
90 |
Number Of Beneficiaries Age 65 to 74 |
123 |
Number Of Beneficiaries Age 75 to 84 |
83 |
Number Of Beneficiaries Age Greater 84 |
26 |
Number Of Female Beneficiaries |
193 |
Number Of Male Beneficiaries |
129 |
Number Of Non Hispanic White Beneficiaries |
202 |
Number Of Black or African American Beneficiaries |
78 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
28 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
228 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
94 |
Percent Of With Atrial Fibrillation |
21 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
24 |
Percent Of With Cancer |
18 |
Percent Of With Heart Failure |
41 |
Percent Of With Chronic Kidney Disease |
50 |
Percent Of With Chronic Obstructive Pulmonary Disease |
53 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
37 |
Percent Of With Hyperlipidemia |
48 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
50 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
12 |
Average HCC Risk Score Of Beneficiaries |
2.4997 |