National Provider Identifier [NPI]: |
1184769424 |
Last Name Of The Provider |
PETTUS |
First Name Of The Provider |
SONJA |
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 |
1450 JONES DAIRY RD |
Street Address 2 Of The Provider |
BLDG 700 |
City Of The Provider |
JASPER |
Zip Code Of The Provider |
355016106 |
State Code Of The Provider |
AL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
122 |
Number Of Services |
6386 |
Number Of Medicare Beneficiaries |
632 |
Total Submitted Charge Amount |
500530.54 |
Total Medicare Allowed Amount |
318529.89 |
Total Medicare Payment Amount |
230418.65 |
Total Medicare Standardized Payment Amount |
251087.88 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
14 |
Number Of Drug Services |
2744 |
Number Of Medicare Beneficiaries With Drug Services |
263 |
Total Drug Submitted ChargeAmount |
22960 |
Total Drug Medicare AllowedAmount |
6708.35 |
Total Drug Medicare PaymentAmount |
5558 |
Total Drug Medicare Standardized Payment Amount |
5558 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
108 |
Number Of Medical Services |
3642 |
Number Of Medicare Beneficiaries With Medical Services |
632 |
Total Medical Submitted Charge Amount |
477570.54 |
Total Medical Medicare Allowed Amount |
311821.54 |
Total Medical Medicare Payment Amount |
224860.65 |
Total Medical Medicare Standardized Payment Amount |
245529.88 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
112 |
Number Of Beneficiaries Age 65 to 74 |
205 |
Number Of Beneficiaries Age 75 to 84 |
208 |
Number Of Beneficiaries Age Greater 84 |
107 |
Number Of Female Beneficiaries |
438 |
Number Of Male Beneficiaries |
194 |
Number Of Non Hispanic White Beneficiaries |
603 |
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 |
464 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
168 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
23 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
28 |
Percent Of With Chronic Kidney Disease |
50 |
Percent Of With Chronic Obstructive Pulmonary Disease |
22 |
Percent Of With Depression |
28 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
38 |
Percent Of With Osteoporosis |
19 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.2987 |