National Provider Identifier [NPI]: |
1184690448 |
Last Name Of The Provider |
DURANT |
First Name Of The Provider |
TAMMY |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2714 RIVERVIEW DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
HOWARD |
Zip Code Of The Provider |
543136715 |
State Code Of The Provider |
WI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
104 |
Number Of Services |
1548 |
Number Of Medicare Beneficiaries |
153 |
Total Submitted Charge Amount |
162839.24 |
Total Medicare Allowed Amount |
46452.9 |
Total Medicare Payment Amount |
36052.13 |
Total Medicare Standardized Payment Amount |
38054.19 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
81 |
Number Of Medicare Beneficiaries With Drug Services |
46 |
Total Drug Submitted ChargeAmount |
3666 |
Total Drug Medicare AllowedAmount |
1205.25 |
Total Drug Medicare PaymentAmount |
1160.61 |
Total Drug Medicare Standardized Payment Amount |
1160.61 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
95 |
Number Of Medical Services |
1467 |
Number Of Medicare Beneficiaries With Medical Services |
153 |
Total Medical Submitted Charge Amount |
159173.24 |
Total Medical Medicare Allowed Amount |
45247.65 |
Total Medical Medicare Payment Amount |
34891.52 |
Total Medical Medicare Standardized Payment Amount |
36893.58 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
36 |
Number Of Beneficiaries Age 65 to 74 |
66 |
Number Of Beneficiaries Age 75 to 84 |
32 |
Number Of Beneficiaries Age Greater 84 |
19 |
Number Of Female Beneficiaries |
116 |
Number Of Male Beneficiaries |
37 |
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 |
121 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
32 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
16 |
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
7 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
25 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
58 |
Percent Of With Ischemic Heart Disease |
28 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
29 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9871 |