National Provider Identifier [NPI]: |
1720095276 |
Last Name Of The Provider |
KENNEDY |
First Name Of The Provider |
SUSAN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
DO |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
411 LAUREL ST |
Street Address 2 Of The Provider |
SUITE A120 |
City Of The Provider |
DES MOINES |
Zip Code Of The Provider |
503143017 |
State Code Of The Provider |
IA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
66 |
Number Of Services |
2402 |
Number Of Medicare Beneficiaries |
357 |
Total Submitted Charge Amount |
170205 |
Total Medicare Allowed Amount |
81803.93 |
Total Medicare Payment Amount |
55514.97 |
Total Medicare Standardized Payment Amount |
61137.33 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
13 |
Number Of Drug Services |
184 |
Number Of Medicare Beneficiaries With Drug Services |
76 |
Total Drug Submitted ChargeAmount |
2767 |
Total Drug Medicare AllowedAmount |
1839.55 |
Total Drug Medicare PaymentAmount |
1706.55 |
Total Drug Medicare Standardized Payment Amount |
1706.55 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
53 |
Number Of Medical Services |
2218 |
Number Of Medicare Beneficiaries With Medical Services |
357 |
Total Medical Submitted Charge Amount |
167438 |
Total Medical Medicare Allowed Amount |
79964.38 |
Total Medical Medicare Payment Amount |
53808.42 |
Total Medical Medicare Standardized Payment Amount |
59430.78 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
110 |
Number Of Beneficiaries Age 65 to 74 |
146 |
Number Of Beneficiaries Age 75 to 84 |
64 |
Number Of Beneficiaries Age Greater 84 |
37 |
Number Of Female Beneficiaries |
273 |
Number Of Male Beneficiaries |
84 |
Number Of Non Hispanic White Beneficiaries |
281 |
Number Of Black or African American Beneficiaries |
29 |
Number Of AsianPacific Islander Beneficiaries |
26 |
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 |
227 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
130 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
50 |
Percent Of With Hypertension |
59 |
Percent Of With Ischemic Heart Disease |
23 |
Percent Of With Osteoporosis |
4 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0184 |